Clinically integrated network looks to assist patients with health management, especially chronic conditions
Last year, Penn State employees and their adult dependents living in Centre County began receiving calls from Penn State Health Care Partners’ care managers as part of a free and innovative pilot program to provide employees and their families access to broader resources to monitor and manage health conditions, and curtail rising health costs.
An emerging approach among employers seeking to stem rising health care costs is the development of programs and services that stabilize and even reduce costs by helping employees better manage their health and medical conditions, with an emphasis on proactive and coordinated care for chronic health issues like asthma and diabetes.
ARTICLE: Chronic Condition Management
That’s the goal of Penn State Health Care Partners’ clinically integrated network.
Penn State Health Care Partners, which includes Penn State Health Milton S. Hershey Medical Center and Medical Group practices, Mount Nittany Health and Mount Nittany Physician Group, Penn State Health St. Joseph Physician Hospital Organization, and Lancaster-based Physicians Alliance, is an Accountable Care Organization, a group of doctors, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care while containing costs.
Penn State Health Care Partners coordinates the efforts of local physicians and health care facilities to provide comprehensive care and support to individuals with chronic conditions, and will help Penn State employees and their families achieve optimal management of their health conditions, and ultimately lower overall health care costs.
ARTICLE: Local Physician participation
“The benefit of Penn State Health Care Partners is that it gives Penn State faculty and staff, and their families, access to broader resources to better monitor and manage special health conditions, such as asthma, coronary artery disease, diabetes, hyperlipidemia, hypertension and obesity,” said David Gray, Penn State’s senior vice president for Finance and Business.
Penn State Health Care Partners’ care managers work with the physicians of Penn State’s University Park employees and adult dependents (members) to identify intervention opportunities for those high-risk members based on their chronic condition and treatment history. Care managers contact members to discuss their conditions, treatment options and to offer assistance or guidance with any healthcare related issues.
Care managers are held to the same high standards of patient confidentiality as any health care worker under the Health Insurance Portability and Accountability Act, commonly known as HIPAA.
ARTICLE: Secure Data Sharing
However, because patient privacy and confidentiality are paramount, Penn State members can choose to opt out of the service from the moment they receive their first care manager call, and no one at Penn State will know anything about an employee’s condition or treatment whether or not the member chooses to stay in the program or opts out.
Penn State Health Care Partners piloted a successful care manager program and collected a long list of success stories.
One such case involves a care manager assisting a patient with obtaining newly prescribed anti-nausea medication. The patient was prescribed a medication that would cost nearly $500 every month after insurance coverage. After researching options, the care manager, working with both the patient and the patient’s physician, discovered the pill version of the medication would only cost the patient $68 per month. Additionally, the care manager knew of a local pharmacy which offered the same medication on their $9.99 generic medication list. After conferring with the patient’s physician, who approved the adjustment, the care manager worked with the patient and family to switch to the new medication. The care manager helped the patient obtain his new medication, from which the patient showed some improvement, without further delay and at a dramatically lower cost.
“Our care managers are here to assist your primary care physician. They are able to reach out and fill-in the gaps between visits and help Penn State faculty and staff really manage their own health,” said Dr. William Bird, chief medical officer for Penn State Health Care Partners and chair of family and community medicine for the Milton S. Hershey Medical Center.
In addition to the improved care for Penn State members, Penn State Health Care Partners is also a financially responsible model that takes advantage of reimbursement policy changes in the Affordable Care Act, which rewards quality and value over the fee-for-service model. Under the new guidelines, previously competing providers can work together to voluntarily coordinate high-quality care for a large group of patients.
“Penn State Health Care Partners’ coordinated-care model provides the best alignment of resources and will eventually bend the cost curve in favor of employees, their families and Penn State,” said Gray.
The focus on chronic disease management is particularly important to the Penn State community. For families with employer-sponsored health care, chronic illness increases physician and medical facility visits, and creates greater out-of-pocket costs, including premium contributions, copays, coinsurance, deductibles and prescription drug costs.
For more information on Penn State Health Care Partners, visit the website http://pennstatehealthcarepartners.org/