By Genevieve Caruncho-Simpson
The new mission for health care providers should primarily focus on how they can help their patients reach their health ambitions. The traditional health care experience is being redefined by new business models and competitors, but also by the changing consumer habits and their expectations of health care providers. As health care moves to a new consumer-driven era, driving patient satisfaction and loyalty is not limited to providing excellent patient care in one’s facility or provider office. It is migrating to a more holistic service model centered around relationships, convenience and affordability.
The process of caring for patients is beginning to shift, as the fee-for-service model becomes a thing of the past. The idea of fitting in as many patients as possible per day leads to inefficiencies over time, as inadequate care during the initial visit can result in multiple follow-up appointments and treatments. By changing the focus from quantity to quality, health care providers can decrease the number of readmissions and overall improve the patient care experience.
The future is the value-based care model, where physicians are reimbursed for providing quality and coordinated care. This incentivizes the physician to focus more time on improving how they care for patients. One way providers are moving to a value-based care model is through partnerships with other care facilities and insurance companies in the form of joint ventures where incentives and initiatives are aligned for a streamlined approach. Consider the following methods and how a partnership or combined efforts can help increase quality care for all patients.
Localized Care Management
Quality care should be personal, local and customizable. Localized care management programs eliminate the frustration that may result from lack of communication among members, providers and insurance companies. Patients are no longer stranded with the inconvenience of speaking over the phone to a nurse located states away. Instead, they can discuss questions or issues with local health advocates who are familiar with their personal health goals and issues, and aware of whether it is related to the unique health care landscape of their area.
One way to provide localized care is through a joint venture, where a national insurance company partners with a local health care system. Unfortunately, traditional insurers often lack this local perspective, but joint ventures can provide that personalized care as the teams are located in the same city or region as members.
For example, Texas Health Aetna is a joint venture in the Dallas-Fort Worth area between Texas Health Resources and Aetna. By leveraging the strengths of Texas Health Resource’s clinically integrated, local network and local care management capabilities and Aetna’s national insurance expertise and diversified health care benefits, the company can provide personalized and customized care at a lower cost to North Texans. Much of the focus on Texas Health Aetna’s care redesign initiatives are on building a care culture focused on each member’s health journey, whether it is enabled by the health plan or the health system, and restoring the human element to the health care experience.
Personalized Services Driven by Data
Something as simple as a doctor’s visit requires a considerable amount of paperwork and ongoing data, especially when multiple appointments are required for additional specialists beyond the general practitioner. The solution to improving quality care is implementing an integrated system that keeps all key member information between clinical care teams and insurance claims current and properly analyzed for better care insights. Often, this also results in a reduction of repetitive work imposed by the traditional siloed approach to health care and allows providers to focused on activities that drive real value to the patient.
Having a preferred network of hospitals and providers that are engaged, share a common approach to care delivery, and have the resources to help them easily analyze and keep track of patient information are critical to improving the member’s experience. The ability to coordinate real time, with richer data from insurance claims and care facilities, gives physicians a clearer understanding of patients’ health history. The data is then also used by the insurance provider to analyze pain points and work to mitigate those in the future. Consider also implementing local health advocates who can personally guide patients throughout their health care journey and ensure they are receiving timely, quality care.
Texas Health Aetna takes this personalization one step further by providing local multidisciplinary care teams to service the top five percent of members who typically generate more than 50 percent of the costs on an employer health plan. Social, economic and environmental factors can affect a patient’s health, so by taking a holistic care approach and providing a dedicated medical director, pharmacist, nurses, social workers and diabetic educators, the company can better serve higher-risk members.
Virtual Care App
Technology is constantly advancing, which makes it crucial for health care providers to implement new resources to serve patients better. A key factor in excellent patient care is convenience. By utilizing a virtual care app, members can have access to physicians to gain advice on non-emergency issues and avoid a costly trip to the emergency room.
Additionally, the Centers for Disease Control and Prevention’s 2016 Workplace Health Promotion estimates productivity loss due to employee medical issues costs $1,685 per employee per year. By utilizing a virtual care app, employers can worry less about employees leaving during the day for doctor appointments or spending time researching symptoms online. With the app, members can get non-emergency symptoms checked and questions answered within minutes, allowing for more focus on work and fewer distractions.
The Texas Health Aetna ER Doc app is staffed by independent, board-certified ER doctors who also staff the Texas Health Resources’ emergency departments. Through it, members can text or video chat with a local doctor 24/7 through their mobile device or computer without incurring additional cost shares.
It is crucial health care organizations understand the importance of utilizing new solutions and programs that ensure the care process runs more efficiently. Value-based care models are the future of the health care industry, and those providers that focus on providing excellent care will see success in their business and reputation among patients.
About the Author
Genevieve Caruncho-Simpson is the chief operating officer of Texas Health Aetna, the jointly owned health plan focused on improving quality, affordability and overall member experience between Texas Health and Aetna. The company represents two leading health care organizations coming together to fundamentally transform the health care experience for members through technology-enabled data-driven analytics and enhanced local care management. For more information, please visit www.texashealthaetna.com
The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.
Excellent write up. simply put and conviving. Being a practitioner in India we are in a situation where affordability ranges from minimal ( Read 5 $) to capacity to personally book an air ambulance to get best healthcare anywhere in the globe.
Genevive, I think you have an interesting perspective. I can see how the process of caring for patients is beginning to shift. It’s bound to happen, especially with advances in technology.