Connecting with our members…
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Believe it or not, some of the “fan mail” I get from Harvard Pilgrim members is pretty positive. I certainly hear from people who think we’re not living up to our #1 in the country J.D. Power rankings, but I also hear from people who think we’ve made a positive difference. I got a letter a couple of weeks ago from a 35 year-old woman who’s been battling cancer. She wrote a long letter to me about Harvard Pilgrim and Donna C., her nurse care manager. She starts the letter by saying it is a hard letter to write, and it’s way overdue – mostly because she doesn’t know where to begin. “I have had such a difficult time finding the right words to express my gratitude and appreciation for Donna’s help through what I hope to be the worst time in my life…Donna has filled a void in this situation that I didn’t know was going to exist…Throughout this ordeal Donna has been top notch in her professionalism, yet incredibly friendly. Each time I speak with her I am amazed with her knowledge and her ability to provide insight into almost every facet of this situation…I am thankful for a whole lot of things in my life, and I am exceptionally thankful I have had someone like Donna to help me through it.”
Not all health insurance plans invest as much as we do in supporting our members, but most do put time, talent and money into helping their members deal with their health. We use a variety of channels, too. Some are as simple as a letter letting you know it’s time for a mammogram. Some involve using automated interactive voice recognition technology over the phone to call members who fall into certain categories and need to either be reminded about something (time for a colonoscopy!!), or given a chance to investigate an opportunity to save money (the chronic med you’re on is available as a generic). We also call every member who signs up for a health insurance plan that has a deductible to make sure they understand how the deductible works, and that we’re available to help them with the details if/when the time comes that they have to use it.
We also call people who get discharged from the hospital - to ask, first of all, how their care was, but also to find out if they have any questions about their aftercare (they almost always do, and most of the questions involve follow-up meds and appointments).
In fact, we interact with subsets of our membership at various levels and in various ways all the time. This has replaced, in many ways, our historical efforts to communicate with and influence care delivery at the point of service. Today, it’s much more effective - and helpful - for us to reach out to our members in one way or another - to make them smarter about their health care, their benefits, and their own health status - than it is to engage with clinicians.
You provide numerous examples of the good work that a good health plan can do to help members directly improve their health status and to bring value to health care. But, I believe that a good health plan does not need to choose between working with members and working with providers to positively impact the cost and quality of health care. Rather, the opportunity to make a difference can be seized by BOTH educating and working directly with members AND by educating, incentivizing, and collaborating with Providers. Certainly, there are many opportunities for Harvard Pilgrim to leverage the provider/patient relationships and to work directly with hospitals and other larger physician groups to promote key safety, quality and efficiency efforts. For example, health plans can share actionable information with their contracted providers, as well as promote evidence-based guidelines and appropriate use of technology through Pay for Performance arrangements. By incentivizing providers through their contract and payment terms, a health plan can move providers up the quality continuum. I agree that a smaller health plan has a more difficult time impacting provider behavior than would Medicare or even BC/BS of Mass, but a certain amount of incremental good is possible by strategic use of resources in partnership with receptive providers. I believe that one should approach complex problems from multiple angles and with multiple strategies. Improving quality and cost of health care is certainly a complex problem with many underlying root causes. We should therefore seek innovative solutions through diverse paths.
Right on, Leanne. For example, if health plans provided a kind of global fee to doctors for primary care for diabetes patient management (i.e., not related to each visit), perhaps that would help with care of this chronic illenss. Not full capitation, where all the specialty and tertiary care is included and where the primary care doctor has to engage in risk-sharing gamesmanship, but a kind of capitation for the primary care doctor. Maybe, too, throw in incentives for the PCP if s/he achieves specific metrics for the patient’s well-being.
How about trying that with (ahem!) a specific group of PCPs in the HPHC network.
Let’s talk about ways to combine provider and consumer incentives using the diabetic example. The diabetic is the one that needs to pick up the phone and schedule quarterly visits with the endocrinologist (whose schedule is jammed 4-6 months out), test his blood sugar regularly, take insulin, eat right , and exercise so that his Hba1c is on target. This is no short order: I know because I have a 14 y.o. who is a Type 1 diabetic. AND even with the excellent benefits I have through my employer, supplies and co pays were $1500 out of pocket last year. Lots of potential barriers for a consumer. Am I personally incented to keep my child healthy? Absolutely. That is the real driver for me. But time and money barriers are real for some people. The evidence is pretty clear about the importance of keeping your blood sugar under control. Influencing provider and consumer behavior can be tough. Would health plans consider incenting providers on patient compliance? Access? Could benefit designs be changed to incent consumers to be more compliant?
Interesting conversation, especially seeing the idea of incentives from the perspective of both the provider and the patient/consumer. What will be more interesting is to see how far these 2 connected groups will be willing to take this idea when it comes to cost controlling measures. When Mr. Levy suggests incenting provider groups for meeting certain benchmarks, would he also accept reduced reimbursement if those standards were not met? What process could be employed to set those quotas while at the same time maintaining transparency? Will patients accept fluctuating rates if they fail to maintain a predetermined level of health? Again, how would these “levels” be set, and by whom? It would be hard to imagine the consumer responding favorably to these, or for that matter any, incentive laden plan without first knowing that there is a commitment from providers and insurers to maintain the program’s integrity. Likewise, providers would have to have a measure of faith in their patient’s abilities to “hold up their end of the bargain” so to speak, before agreeing to variable reimbursement. These scenarios only get more interesting (and complicated) when MA Health Care Reform is thrown in the mix, and “minimum creditable coverage” standards are applied. Could we be seeing the dawn of wide-spread ’supplemental’ health insurance? We’ll see…
Hi, I have an opposite view from your fan & consider some activities done under the header of ‘connecting with your patients’ as intrusive & wasteful given the data you have in your systems.
Let me explain. I am an asthmatic and have been one for over 30 years. Not counting the first few years, blame them on being a teenager, I am a well-controlled asthmatic. What does this mean? I faithfully fill my prescription for inhaled steroids, rarely fill one for albuterol and have not been to my physicians office for asthma problems although it does get coded when I show up for my annual exams.
But, without fail, I receive information about how to control my asthma every year. The past few year it has contained stickers to paste on my inhalers. Is this just in case I forget which one is which?!? This year the tactics changed. An automated phone call was place to my house, leaving the message that I needed to call because they had ‘IMPORTANT HEALTH INFORMATION’ for me. I bit, mostly because I had just submitted a new prescription to the mail order company & was concerned there was a problem. But, to my annoyance, it was a machine asking me if I controlled my asthma & congratulating me on a good job - give me a break! And then I received a letter from Roberta Herman telling me I was now automatically enrolled in some asthma program - lucky me…
Why does all of this annoy me? My day job is a health care data analyst and I am well aware that the data needed to tell your care management group whether or not I am controlled & compliant is in your systems. Rather, the easy way is taken, the ICD9 code code for asthma is flagged & I get dumped into the pile. How much money is being wasted sending patients like myself stickers & machine-generated phone calls when it just takes a few more lines of code to determine that I do not need this information?
Thanks, Ann