Although the practice is not being paid for the additional outreach, Spencer explains the startup cost has been minimal—one full-time care manager, which eventually became seven, whose efforts pay for themselves through the number of routine health maintenance appointments that are scheduled. Additionally Crystal Run is renegotiating the organization’s health plan contracts in the hopes that payers will recognize the value of the model.
“We are talking to our health plans about the value these programs bring to patients and the decreased risk. We are looking to do more population management, which was more in the health plan domain, and we hope things change in this area in the coming years,” he adds.
Technology, Employer-based Clinics, and Population Health Management
Nonadherence, or the failure of patients to take prescription medication as directed, is linked to poorer health and higher death rates among people with chronic disease. And lack of communication between the patient and physician can contribute to the problem.
When it comes to chronic care and population health management, the healthcare providers at Prevea Health believe that better communication is the key to improving a patient’s overall health, and that extends beyond the clinical encounter. With 200 providers covering 20 locations, this multispecialty practice in Green Bay, WI, found an automated patient identification and outreach program to be one part of ensuring that patients with chronic conditions in need of care received the necessary treatment. The other part was making access to the doctors easier by working with local employers.
Ashok Rai, MD, Prevea Health’s president and CEO, led a study of the organization and reported the results in the journal Population Health Management. The study found that patients who received automated communication messages were more likely to have both a chronic-care office visit and an appropriate test than patients who were not contacted.
Diabetes patients who were successfully contacted were significantly more likely to have both a chronic care–related visit and an HbA1c test than their counterparts who were not contacted. Hypertension patients were also significantly more likely to have both a chronic care–related visit and a systolic blood pressure reading recorded in an electronic medical record. The results of this study indicate that a well-designed outreach program motivates patients who have gaps in care to have their treatment needs addressed.
Founded in 1996, Prevea Health partners with St. Mary’s and St. Vincent Hospitals in Green Bay, and St. Nicholas Hospital in Sheboygan, providing access to more than 200 providers in over 50 specialty areas. The practice is a rare, 50/50 partnership between Prevea and the Green Bay three-hospital system. The relationship with the hospitals along with Prevea’s numerous locations created a challenge when the practice decided to approach population health management. While the organization focused on this problem, it got the practice members thinking that from a business perspective, Rai says, creating a program such as a Medicare ACO would only add 2% to its reimbursements for Medicare, and that just didn’t make sense. The practice wanted to design a population health model that extended to the commercial market as well.
“PPACA is so fixated on improving the quality of care for those who don’t have insurance, but we wondered—because we’re an employer—how are you going to save the employers money? They’re struggling to pay for healthcare,” he says. It was a question Rai says the organization hadn’t intended to address when it launched the first part of its population health management program.
Initially the group practice added a patient identification and outreach program, Phytel’s Proactive Patient Outreach, to address the situation. The program uses data feeds from the group’s practice management system, and in turn builds a registry of patients who require preventive and chronic care. The technology triggers automated messaging to high-risk patients when they are due for office visits, tests, or other services.
“We were having good success with our EMR improving quality,” says Rai. Still, like all practices, it needed to continue to grow a large and loyal patient base. Prevea Health considered creating an ACO, but realized there may be another direction to head.
“We recognized that there was an opportunity that was being ignored by PPACA—a group we can relate to: the employer. If we created an ACO, then we would be accountable for caring for the population from our worst payer: Medicare. We want to help those patients, but from a business standpoint they couldn’t be our sole focus. You can’t spend all your time ignoring your best-paying customers,” Rai explains.
The question became: How could the physician practice bring the value of population health management to the employers? “We knew we could save them money, but the employer needed to see the value,” he says.