posted by Warren Murrell, Peoples Health
on April 4, 2017
In 2012, Peoples Health saw the need for a complete overhaul of how we supported coordination of care for our Medicare Advantage plan members in Louisiana. In response, we formed the concept of the Peoples Health Medical Management Model (Model).
The heart of the Model is that our members’ health care needs should guide every care decision that is made. The Model surrounds our 60,000 members with a group of enhanced primary care practices in our provider network, as well as our own team of nurse navigators, nurse practitioners, care coordinator social workers and care coordinator nurses, and other clinical support professionals. This pairing allows us to support the highest levels of preventive, chronic and acute care management.
The Model also allows Peoples Health to engage more with providers and together focus on our members – their patients – in a more holistic way, to foster optimal health outcomes.
Right care, at the right time, in the right place.
Mindset Change Needed
Why did we pursue such a change? The traditional approach to care, called the tried-and-true approach by many, faced more and more issues, including:
But, with change comes challenge. We needed to convince not only the providers in our network, but also our employees, that this Model was the right approach. The main problems we encountered were that our providers did not want the intrusion and our employees did not want to alter long-standing processes.
To be successful, we had to change beliefs, behavior and culture.
Our leadership became the catalyst, the driver and the change agent. Our leaders sought to inspire and motivate both providers and employees to see beyond their current roles and embrace the potential that new and redefined roles, in line with the Model, could offer us in how we supported our members’ health care.
Providers and employees alike were introduced to the concept of the Model very early in its origination and were encouraged to be active participants in its development and implementation. They were given a voice and a platform to share ideas.
Not all accepted the concept initially, but slowly over time, more and more joined in the belief that this was the right approach.
Today, the fully implemented Model has resulted in several benefits to our members:
Members are becoming more active, informed participants in their health care, getting the preventive screenings they need and proactively being involved in their health care.
We’ve also implemented medication management programs that have greatly reduced our members’ use of high-risk medications from 13 percent (1 star) down to 3 percent (5 stars).
The additional benefit is that many of these screenings and services are connected to the Star Ratings that CMS issues Medicare health plans. The more we can support our members in getting the health care services they need, the more that our CMS Star Rating – which is four stars for 2017 – will reflect the level of quality care and care coordination support that we offer.
We believe that by empowering members to have a vested interest in their health, the lines of communication between health care provider, health plan and member become more open – which ultimately benefits the member’s health in the long term.
To learn more about Peoples Health, visit www.peopleshealth.com.
Warren Murrell is Peoples Health President and CEO.