Health Maintenance and Disease Prevention Programs are Essential Drivers of Patient Health

Historically physicians have provided healthcare one patient at a time to diagnose and treat illness or symptoms. However, in this era of increasing healthcare complexity and cost, it is essential that we expand our focus beyond a single patient to populations and communities, many of whom are healthy and well and desire to remain that way. Among these populations disease prevention is taking on greater importance as a way to improve health outcomes and lower total healthcare expenditures.

To accomplish these goals, physicians and health plans must partner in outreach programs focused on screening, prevention and health maintenance. It is disturbing that even today among the insured populations provided healthcare screening benefits at no out-of-pocket costs, a large number of members fail to obtain even the minimum recommended screening and preventative measures.

Health plans have an essential role to play in the effort given the fact that seven out of 10 people who are unscreened are covered by insurance. Among the noteworthy examples taking place around the country is one in North Texas where Care N’ Care Medicare Advantage health plan turned its attention to a screening program for colorectal cancer (CRC), the second leading cause of cancer death nationwide among men and women combined. At that time less than 40 percent of eligible members were being screened for CRC. Care N’ Care worked with physician leaders to design the most effective approach for their members and an efficient process for the physicians and their office staff. Together they created a program to provide fecal immunochemical test (FIT) kits for all members who had not met recommended CRC screening recommendations. When Care N’ Care’s primary care physicians were invited to participate, virtually all accepted.

Since 2013 Care N’ Care has achieved a greater-than 75 percent CRC screening rate, earning the plan a Medicare 5-Star rating for 2013-2015. And in 2016 Care N’ Care was recognized for its “best practice” in the National Colorectal Cancer Roundtable Handbook. To further improve member adherence with the CRC screening program, Care N’ Care incorporated the outreach and friendly touch of it’s Healthcare Concierge Service. Here every member is assigned a personal concierge to serve as their advocate and assist them with all their healthcare needs (billing issues, appointments, prescriptions, questions, etc.). After members were mailed their FIT kits, their personal concierge made regular outreach calls to assure that the kits were returned for testing. Increased adherence leads to fewer colorectal cancers and more lives saved.

To further inform and empower its members, Care N’ Care provides them with a personal health journal that includes lists of recommended immunizations, preventive screening tests, and recommended health maintenance measures. Members are encouraged to record important health information, including medications, allergies, blood pressure, and other significant conditions and procedures. Further advice is provided on talking with physicians about difficult topics such as incontinence or memory loss.

In 2016, 17.6 million beneficiaries – 31 percent of the total Medicare population – were enrolled in a Medicare Advantage plan. They choose Medicare Advantage because it allows them to receive all of the benefits of traditional Medicare plus many value-added benefits and services, such as the screening program successfully undertaken by Care N’ Care. These benefits empower seniors to take greater control of their own health, be more productive, and receive the benefits of innovative population health management programs.

Tom Deas, Jr., M.D., is president of the Care N’ Care board of directors.

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