This is the second in a series in which the Penn State Office of Human Resources explains how participation in a clinically integrated network will assist University employees with effective management of their health and chronic conditions, and positively impact overall medical benefits costs.
Twenty-two percent of Penn State’s medically insured population has one or more of the chronic health conditions of hypertension, diabetes, hyperlipidemia or asthma.
It’s a significant statistic for Penn State employees and their families, and one that translates to increased physician and medical facility visits, a lower quality of life, a loss of productivity at work, and greater out-of-pocket deductibles, coinsurance, and copays for medical services and prescription drugs.
Eventually, the toll is much higher. Chronic diseases – long-lasting and persistent medical conditions like cardiovascular disease, diabetes, obesity, cancer and kidney disease – account for seven of every 10 deaths in the U.S., according to a 2011 Department of Health and Human Services study.
In response, health care organizations, private companies and even educational institutions are developing partnerships to bring chronic disease management programs to their insured populations in order to more effectively and comprehensively manage their overall health.
That’s the goal of Penn State Health Care Partners, a clinically integrated network that will coordinate 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. This coordination of care by Penn State Health Care Partners’ care managers is provided at no additional cost to Penn State employees and their dependents covered by the University’s health benefits plan.
“Clinically integrated networks use an approach to population health management that incorporates a team-based model to improving health outcomes,” said Dr. William Bird, chief medical officer for Penn State Health Care Partners. “A team composed of physicians, specially trained registered nurses, pharmacists, and social workers are able to help coordinate care with the patient’s personal provider. The goal is to improve the outcome and experience for the individual patient while helping to improve the health of the total population.”
Beginning in April, Penn State Health Care Partners’ care managers will 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 will then contact members to discuss their conditions and treatment options, and to offer assistance or guidance with any healthcare related issues, including but not limited to nutrition and exercise options, medication choices, and stress and pain management.
While 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, 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.
During a pilot of the program at another institution that Penn State Health Care Partners conducted last year, care managers proved integral to the coordination of care across the continuum of primary, specialty and sub-specialty care, including prevention and screening, therapy and rehabilitation services and chronic disease management.
In one case, the care manager identified a patient who was discharged from the hospital with an artificial heart, but was released without plans for home care, physical therapy/occupational therapy or follow-up appointments. The care manager’s intervention was instrumental in connecting the patient with the necessary services to have a positive outcome. The patient has since reduced her cardiology appointments from every two weeks to monthly.
Penn State Health Care Partners’ physician and care providers will also have the unprecedented opportunity to help identify, share and institute best practices for patient care; thus, improving the chances of positive clinical outcomes for all patients. In fact, improved quality and positive patient outcomes will be the measure of success for Penn State Health Care Partners.
For more information on Penn State Health Care Partners, visit the website http://pennstatehealthcarepartners.org/
Find the first article in this series, “Penn State Health Care Partners seeks to help with optimal health management” here.