Care Shouldn’t Start in the Emergency Room

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An emergency room is too often the first choice for medical care, even when alternative care options are available. According to a 2015 survey by the American College of Emergency Physicians (ACEP), 75 percent of ER doctors reported an increase in patient visits since January 2014, with nearly 90 percent reporting either stagnation or worsening in their patients’ conditions. However, this is not an irreversible trend. There are steps healthcare providers can take to reduce the number of emergency room visits and, in turn, lower healthcare costs.

One of the most effective approaches is population health management because it improves patients’ overall health and wellbeing and provides tools so that they can take greater control of their healthcare. The numbers prove population health management is making a difference for US Family Health Plan members. Our beneficiaries under age 65 make 40 percent fewer trips to the emergency room than non-USHFP beneficiaries while spending 50 percent fewer nights in the hospital, according to the consulting firm Milliman. Care for our patients does not start in the emergency room—it starts at home. USFHP members are encouraged and empowered to invest in their own health through wellness initiatives. Programs like health literacy training, flu outreach reminders and weight management and smoking cessation programs help our members get healthy and stay healthy. When they do need medical attention, USFHP members enjoy an integrated care network in which providers share patient information seamlessly.

Another key USFHP approach that helps reduce ER visits is making sure patients have access to care. A 24-hour nurse help line, the use of a primary care manager, the availability of urgent care centers for immediate but non-emergency care, and in-home patient monitoring are quality alternatives to the emergency room. Improved wellness combined with quality, coordinated care results in healthier patients who, in the long term, save money by avoiding hospital visits and receiving less frequent medical attention. They are also proving to remain highly satisfied with their care: nearly 93 percent of USFHP beneficiaries rate their health plan above-average according to the National Committee for Quality Assurance, compared to only 66 percent for similar plans.

We’re glad to see our patients happy and healthy, not in the emergency room.

Patient-Centered Care Leads to 91.5% Member Satisfaction Rate for US Family Health Plan

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Arlington, VA — While America continues to seek solutions to the need for low-cost, high-quality healthcare, the US Family Health Plan—a Department of Defense program with history of delivering high quality, patient-centered care to uniformed services families— has again garnered exemplary member satisfaction ratings, according to the final report of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey.  The US Family Health Plan, the only fixed price, value-based capitated care program in the Military Health System, has achieved a 2015 aggregate member satisfaction rating of 91.5 percent:  over 25 points higher on a 100-point scale than the national average for satisfaction with commercial health plans.  That’s when compared to the 201 plans documented in the National Committee for Quality Assurance (NCQA) 2015 Quality Compass Report.

Based on the report, 66.1 percent of health plan members nationally report high satisfaction with their plans (rating them an 8, 9 or 10 on a scale of 1-10). By contrast, a whopping 91.5 percent of US Family Health Plan members report high satisfaction with their plan.  The overall objective of the CAHPS® study is to capture accurate and complete information about consumer-reported experiences with health care.

The independent CAHPS® assessment of 4,782 US Family Health Plan members employed the most widely used set of performance metrics in the managed care industry to measure performance on important dimensions of care and service.   It assesses member satisfaction in areas such as claims processing, customer service and getting needed care quickly.

“The US Family Health Plan’s national member satisfaction scores once again exceed the benchmark in all rating areas for the core population, including survey respondents of all ages,” said Debbie Vereb, Executive Vice President, Operations at SPH Analytics, an NCQA-certified HEDIS survey vendor that administered the study of the health plan members.  “US Family Health Plan members report significantly higher satisfaction with customer service, getting needed care, getting care quickly, coordination of care, and how well their doctors communicate with them.”

The US Family Health Plan, a comprehensive healthcare plan, offers the full TRICARE Prime benefit to more than 145,000 military beneficiaries, including active-duty family members, activated National Guard and Reserve family members, and military retirees and their family members.

Linda Marzano, Chief Executive Officer of Pacific Medical Centers and chairman of the US Family Health Plan Alliance board of directors, said, “We are committed to delivering high value to military beneficiaries and to the Department of Defense by focusing on the needs of our members and engaging them in programs to keep them healthy.  Through the use of population health and disease management programs, our goal is to help our members to live healthy lifestyles and minimize their chances of developing chronic conditions.  Our fixed price contracts ensure that DOD and the taxpayers pay no more than any other source of care while beneficiaries are protected from high co-pays and deductibles though medical management.  For us, it’s about the people. We believe our military families deserve the best care we can provide — it’s that simple.”

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About the US Family Health Plan:

An integral part of health care provided to uniformed services dependents and retirees since 1981, the US Family Health Plan program is part of the Military Health System, offering the TRICARE Prime benefit in 16 states and the District of Columbia.  The US Family Health Plan was the first and remains the only true population health/value-based care model in the Military Health System.   The six fully accredited, community-based health care systems, known as designated providers, include Brighton Marine Health Center, CHRISTUS Health, Johns Hopkins Health Care, Martin’s Point Health Care, Pacific Medical Centers, and St. Vincent Catholic Medical Centers.

Note to Editors:  CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Happy Birthday to the U.S. Navy! USFHP Celebrates You Every Day

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Mike

We are grateful to the U.S. Navy and our members like Vince Marion and his wife for their service and dedication. US Family Health Plan exists for one reason: to provide high quality care to our nation’s greatest heroes – our military members and their families. Happy Birthday to the U.S. Navy!

Q&A: An Interview with Chairwoman Linda Marzano

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We recently sat down with Linda Marzano, the new chair of the board of directors for the US Family Health Plan Alliance. Linda will lead the Alliance as Congress is exploring reforms to TRICARE and considering the recommendations made by The Military Compensation and Retirement Modernization Commission in February 2015. Linda, the CEO of Pacific Medical Centers, shares with us her views about the value of the US Family Health Plan program:

 

Q: Your responsibilities at PacMed include overseeing a US Family Health Plan (USFHP) that serves the Pacific Northwest. What were some of your first observations about working with TRICARE and the military healthcare system?

A: What stands out immediately is the commitment to and trust of PacMed by our patients, some of whom have been with us for 15 to 20 years and have wonderful partnerships with their physicians. Many USFHP beneficiaries have had long-term relationships with us—some since the 1980s, before the Plan’s inception, and others who have been with us since Congress created the USFHP and later designated it as a TRICARE program in the 1990s.

I’ve also noticed that unlike some other patient populations I’ve encountered, our patients really listen to their doctors and follow their professional advice. I attribute that, at least in part, to a respect for authoritative expertise forged by their military backgrounds. Our military health patients are also very open to giving us feedback about their interactions with our staff—from how they were greeted to the processes in our clinics—which allows us to continually improve. I very much appreciate that two-way relationship.

 

Q: What is the USFHP approach to working with a patient?

A: We place a lot of value on the relationship between patient and provider. The aggregate patient satisfaction score for all US Family Health Plan programs is substantially above the average for the Department of Defense. We work very hard on patient access initiatives. When a member joins our Plan, our concern is not just about what the member comes to see us for on one particular day. We take a comprehensive approach, considering everything else going on in their lives. What is their family situation? What about their job? What geographic area do they live in? By working with our patients holistically, there is a much better relationship between the patient and the healthcare provider and ultimately better health outcomes. If a patient wants to come in on a given day, we will get them in on that day. It’s always about the patients, all the time.

 

Q: How is technology helping innovate the way USFHP offers its service?

A: Innovative uses of Technology lets us put healthcare on the patient’s terms. Patients can’t always come to the doctor’s office. If it is 10 p.m., your husband or wife is deployed and you have a sick child, it is not manageable. Technology provides an alternative to packing everyone up and heading to the emergency room. We have to be able to use technology in different ways to support healthcare and the demands of the people.

 

Q: USFHP focuses on improving patients’ abilities to manage their own healthcare, which is especially pertinent for management of chronic diseases like diabetes. How is USFHP using preventive care programs to address chronic disease?

A: One of the biggest trends in the healthcare industry right now is a desire by patients to have more control of their healthcare. At USFHP, we are embracing that. When we take a collaborative approach to managing chronic diseases, we can reduce the rate of hospitalization and doctor visits and can also avoid prescribing additional medications that may be required if a condition is not caught early enough. We also focus a great deal on screening and prevention. Take for example our colon screening and all of our cancer screening initiatives. We channel time and energy into our outreach because we want to catch those things early and keep those patients healthier. 

Truly effective preventive care requires attentiveness to patients’ degrees of risk. Our care managers and case managers are trained nurses and social workers who conduct regular outreach to patients. We evaluate all of our patients and identify those we consider high-risk who would benefit from more frequent follow-ups. Once those patients are identified, we work with them on a regular basis to share helpful information related to their health through mail, phone calls and even group meetings.

 

Q: Why has USFHP invested so much in preventive medicine?

A: We know that keeping patients healthy and putting these prevention measures in place helps patients lead better lives. We identify problem areas through evidence-based medicine. We put these programs in place because of our belief in patient-centered medical home and chronic disease management and evidence-based medicine. We want to keep people healthy, we don’t believe in only seeing patients when they’re sick. We want to keep them out of the doctor’s office and out of the hospital, so that’s what led to developing the infrastructure to do the outreach when the patients need it and do outreach to help patients not even need that care.

 

Q: Does the capitated model encourage this type of investment?

A: Absolutely. In a fee-for-service model, a provider is paid when the patient walks through the door, which encourages illness instead of prevention and wellness. With a capitated model, like USFHP features, there is an incentive to institute cost-saving measures. If a plan is able to reinvest in staff or new technology it can operate more efficiently with fewer costs. One example is USFHP predicative modeling, which we use to determine a patient’s risk factor, this helps us prevent problems and keep patients healthy.

 

Q: What lessons have you learned from working with USFHP?

A: We have taken away some great lessons from USFHP and applied them at PacMed, so our commercial patients are enjoying the same benefits. USFHP has a unique capitated model, and we are constantly reinvesting in the program’s infrastructure to support the highly effective case management programs and personnel we have in place (e.g. the social workers, the outreach and the chronic disease management programs).The approach is so effective that we now apply the same care model to our commercial patients at PacMed. Since adopting the new model from USFHP, we’ve lowered our costs by 10 to 15 percent, and our healthcare outcomes are in the top quartile on the Washington Health Alliance website.