Population Health – The US Family Health Plan’s Value-Based Approach to Health Care

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The US Family Health Plan’s population health-based approach to caring for its nearly 150,000 military family and retiree members across the country is unique among TRICARE Prime providers in the Military Health System.

Dr. David Howes, president and CEO of Martin’s Point HealthCare in Maine, explains how the US Family Health Plan’s value-based approach to health care promotes better health outcomes.

“Population health means that we will understand the health and needs of each and every member of the US Family Health Plan.  And that we will work to help those members to remain healthy and when sick to regain their health quickly,” Howes says.

Preventive health measures, such as weight loss programs and patient risk profiling allow the US Family Health Plan’s member organizations to stay in front of members’ chronic conditions and keep them well.

“Patients come to us, and many times they don’t have a chronic disease yet,” Howes explains. “So by understanding our members and understanding all of their medical circumstances, we can actually often intervene in their diabetes, their high blood fats and their weight, or in other areas of their life where we can help them to reduce the risk of becoming ill and prevent them from getting sick, rather than treating them when they become sick.”

This proactive approach to health care helps military families and retirees if they eventually do develop a chronic illness.  According to an analysis by the Centers for Disease Control (CDC), nearly half of all adults in the U.S. (117 million people) suffered from at least one chronic health condition, while 25 percent had more than one chronic condition.

“It’s awfully likely that most of us will develop chronic illness, and that really requires that we custom-tailor programs to the needs of our members so that they can have the doctors they need, the care support that they need, and the family and personal support that they need,” Howes says. “Those things both improve the quality of their lives, often reduce the progression of their illness, and help them to stay out of the hospital and stay well.”

The US Family Health Plan’s preventive health care initiatives, including disease and complex care management programs and a patient-centered medical home concept that includes in-home patient monitoring, keep members active in lifestyle programs and invested in their health and wellness. This model of care falls closely in line with recent requests by Congress to reform the Military Health System and contributes to keeping US Family Health Plan members satisfied with their health care, out of the hospital and able to experience a high quality of life.

Celebrating National Nurses Week with US Family Health Plan

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National Nurses Week, which began May 6, honors the compassion nurses provide and raises awareness about the important role they play in our health care system.  The US Family Health Plan Alliance appreciates the critical roles nurses play in providing quality health care, promoting patient wellness and improving health outcomes.

As part of our leadership in implementing the patient-centered medical home concept, US Family Health Plan member organizations were among the first TRICARE contractors to offer a 24-hour nurse chat hotline.  The hotline gives our members around-the-clock access to nurses and primary care doctors.  Through the hotline, our members have access to general health information, advice on the use of emergency services, guidance about the appropriate level of care for their medical condition, as well as assistance scheduling appointments.

As National Nurses Week draws to a close, the US Family Health Plan Alliance thanks America’s nurses for their service and tireless dedication to patient care and the health care field.  We could not serve our members without them.

The US Family Health Plan is a Model for Reform within the Military Health System

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United States Senator Tim Kaine of Virginia, co-chair of the Senate Military Families Caucus – which is responsible for addressing challenges facing military families – recently led a roundtable discussion with military families.  At the roundtable, Senator Kaine heard a common theme – the Military Health System can be cumbersome to navigate and is often not very user-friendly for families.

Typical complaints during the discussion included weeks-long wait times for primary care appointments, two-hour waits to get prescriptions filled, and difficulty getting referrals to specialists.  The roundtable also revealed a need for more non-traditional medical care options, such as service animals for disabled children and specialized care for adults with PTSD.  Senator Kaine said he left the conversation with “a lot to think about,” and going forward, he said he would prioritize removing barriers and streamlining the healthcare system to make it easier for service member families to use.

Congress has directed a series of reforms to the Military Health System in the National Defense Authorization Act for Fiscal Year 2017.  These reforms are designed to improve access to and the quality of healthcare, improve health outcomes and enhance beneficiary experiences with the System.  Many of these priorities are already embodied in the US Family Health Plan model of care.

The US Family Health Plan provider organizations understand the culture of our military and the challenges military families face.  US Family Health Plan member organizations strive to ensure beneficiaries get appointments when they need them.  We also work to ensure they receive sustained and reliable access to care through a 24-hour nurse help line, in-home monitoring and other advanced approaches to care delivery.  This value-based approach has kept US Family Health Plan military family and retiree members among the most satisfied healthcare patients in all of TRICARE and is a model for reform to the Military Health System.

Preventive Healthcare is a Secret Weapon for Military Families and Retirees

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Recent research shows that service members and their families can be hesitant to divulge minimal aches and pains to their medical care providers.  Unfortunately, minor injuries and aches and pains often become chronic conditions that can adversely affect job performance and daily living.

Preventive healthcare is critical to preventing illness and injury and to slowing the progression of minor ailments into more serious conditions. The member organizations of the US Family Health Plan program recognize the importance of keeping our military family members healthy so they can live their lives to the fullest.

We encourage family members to participate in their own care, and we believe preventive healthcare is an investment in their future wellbeing.

Because the US Family Health Plan has provided high quality care to military families for over 30 years, our member organizations understand military culture, in addition to the unique healthcare needs of military families and retirees.

Academic research has shown that cultural understanding is key to providing the most effective health care for military populations.  Because we understand the culture, we are better able to focus on population health, prevention programs and disease management.  Our aim is to keep everyone healthy and well, rather than just treating individual episodes of disease when they occur.

By knowing who our patients are, understanding their needs, and clearly communicating their care and treatment options, the US Family Health Plan member organizations are better able to effectively care for chronic conditions like diabetes.  Our value-based model of care also results in fewer emergency room visits, reduced utilization of inpatient services, and achieves better health and wellness outcomes. We strive to ensure our member patients get appointments when they need them and receive sustained and reliable access to care through a 24-hour nurse help line, in-home monitoring and other advanced approaches to care delivery.

Some tips to stay healthy are:

  • Get regular checkups. Visit the doctor regularly and get regular screenings for chronic diseases or illnesses to which you may be predisposed. Frank discussions with providers about your health needs helps you stay healthy and increases the chances diseases will be detected early.
  • Eat nourishing foods. A balanced diet that includes protein, grains, fresh fruits and vegetables helps nourish the body.  Avoiding processed foods is ideal.  Foods high in antioxidants also can help reduce the risk of cardiovascular disease.
  • Exercise regularly. Going for a walk, playing on a sports team or engaging in other physical activities helps keep your body and mind healthy.
  • Take good care of your bones. Bone density is important as we get older.  Be sure to eat enough foods high in calcium and vitamin D in order to keep your bones strong.

A Celebration of Women’s History Month

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March is Women’s History Month, an opportunity to recognize and reflect on the many contributions of women today and throughout history. Central to this occasion is International Women’s Day on March 8, which commemorates women’s bravery and achievements around the world.

The history of the U.S. military to the present day has been marked by the achievements of countless brave women. From Clara Barton’s service as a nurse during the Civil War and the commitment of Gen. Ann E. Dunwoody, the first female four-star general, to those trailblazing women who graduated from the elite Army Ranger School in 2015, women have served, fought and sacrificed for our nation’s security and prosperity.

Women play many pivotal roles in the defense of our country.  They contribute as active duty service members, as members of the National Guard and Reserves, as civil servants, as contractors, and as spouses, parents, children and friends of those who serve. It is vitally important that we recognize and pay tribute to the myriad invaluable sacrifices and service of women to our national security.

The member organizations within the US Family Health Plan Alliance are honored to provide accessible, high quality health care to military families and veterans—and especially to the women who are such a critical component of America’s military community.

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Visit the Department of Defense’s website for an interactive history of women’s contributions to the U.S. military over time.

US Family Health Plan Commemorates U.S. Navy Reserves’ 102nd Anniversary

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The US Family Health Plan Alliance wishes a happy anniversary to the United States Navy Reserve. For 102 years, these brave Americans have seamlessly supported and contributed to the U.S. military mission. The readiness mission extends across the entire military community, including health care, and we are proud to stand behind the brave Reservists who uphold their motto of “Ready Now, Anytime, Anywhere.” The Alliance extends its sincerest gratitude to the members of the Navy Reserve for their continued service.

MEMBER MINUTES VIDEO: Reliable Health Care ‘As Expected’ Through US Family Health Plan

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USFHP Member Minutes Profile

U.S. Marine Corps Gunnery Sgt. Natalie Poole, Retired

Natalie Poole - USMCR2
Natalie Poole enlisted in the U.S. Marine Corps at age 18, looking for direction in her life. She couldn’t know that she would complete a decorated 20-year career that spanned several international deployments – including Japan, the Philippines and Saudi Arabia – and earn five Navy Achievement Medals for service above and beyond the call of duty. Her military service, she says, is the best thing she’s ever done.

Upon her retirement as a gunnery sergeant and logistics chief, Poole has remained active, launching a career as an entrepreneur and government contractor while participating in multiple alumni networking groups and the national organization, Disabled American Veterans. Though she remains physically healthy, she wanted to maintain choice and personal autonomy in her health care. After using other care options offered through the Military Health System, Natalie chose the US Family Health Plan at Christus Healthcare for her care.

“US Family Health Plan had the best program of anything out there,” Poole recalls. “Since I was a veteran, I exclusively had the opportunity to take advantage of it. It was all as I expected. Everyone was respectful, efficient, and there were no surprises. And for me that says a lot.”

As a proud US Family Health Plan member for more than six years, Poole continues to appreciate the respectful culture and unwavering reliability her care teams have offered her since the day she enrolled. She emphasizes how an appreciation of military sacrifice permeates throughout Christus Health, fostering an understanding of military culture that helps doctors and care teams work with veterans who may want to handle challenging situations without outside help.

“Aside from whatever I came in for – including my checkups – they’re also asking me different things to open up the floor [on other medical issues]. They actually talk to me about it in a way that’s respectful,” Poole says. “I’m treated like a human being.”

Another benefit Poole enjoys through the plan is access to care when she needs it. There’s no months-long waiting process to see a doctor; when she calls for an appointment, one is scheduled for her within a reasonable time. This is especially important to her because she has two daughters and four grandchildren – further encouragement to stay as healthy as possible. This also encourages her to participate in the preventive health programs which US Family Health Plan promotes for its members.

“As I get older,” Poole says, “I need a health care plan that’s going to grow with me. It’s very important to me to have consistency and someone that I can depend on — a plan that I can depend on. I believe if you promise a thing you should follow through with a thing. The biggest praise I can give US Family Health Plan and Christus Health is they’ve done exactly that.”

Natalie Poole is among nearly 150,000 US Family Health Plan members nationwide who enjoy access to quality healthcare with top-rated patient satisfaction through six regional member organizations offering TRICARE Prime benefits. To learn more about US Family Health Plan, watch the interview above or explore the rest of our website.

Natalie Poole - Family

 

USFHP Member Series: A Labor of Love

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U.S. Army Family Joins US Family Health Plan
Just in Time for a Planned Home Birth

ComeauxCoupleAfter more than a decade of life as a U.S. Army family, Faith and Aris Comeaux know a thing or two about process and planning.

In 2005, Faith – an Army enlistee from Nebraska – met her future husband, Aris, in Alabama at flight school. They were married, and both eventually became pilots. Faith completed ROTC, became an officer and went on to fly Apache helicopters, while Aris graduated from the U.S. Military Academy at West Point before flying Kiowa choppers. Their service to the Army kept them on the go as they moved to Alaska, back to Alabama, then to California and finally to New York.

It was after living in New York for a year that the Comeauxs – by then a family of six – were preparing to welcome baby number five. Faith, having given birth four times before, knew she wanted this one to happen at home and began making preparations.

 

Former US Family Health Plan member Faith Comeaux flying an Apache helicopter.

Former US Family Health Plan member Faith Comeaux flying an Apache helicopter.

 

“We had one baby that came within an hour, and we had him at home, because we didn’t make it to the hospital. Not by choice, you know. The next one I had at the hospital, so I wanted to do the next one as a home birth intentionally, plan it and set it all up,” she says. “I’ve had beautiful babies, beautiful pregnancies and deliveries and had no issues. The midwife was able to meet with me even with only a month and a half left, and she was comfortable doing it because everything lined up, and it was a safe environment for me and the baby.”

Despite her plans, as her due date approached, Faith’s planned home birth was in flux after she encountered procedural hurdles with her private insurance provider and her preferred hospital.

“It should have been simple, and it became this whole thing,” Comeaux recalls. “I was going to have a home birth one way or the other. Someone said try US Family Health Plan, and so at that point, instead of continuing to fight the hospital to get what my insurance covered, I did call them. I was already over my due date, and the clock was ticking!”

Faith spoke with Rhonda Morris, US Family Health Plan director with St. Vincent Catholic Medical Health Centers – a US Family Health Plan member organization in New York – who worked quickly to onboard Faith and her children as US Family Health Plan members, complete with the benefits of a safe, coordinated home birth.

“I joined US Family Health Plan two days before the baby came,” Comeaux says. “Everything went smoothly. Rhonda was able to get everything from the doctor and made my midwife a primary care provider. Then she had to work on transferring me over.”

Asaph ComeauxWithout a hitch, the Comeauxs were welcomed into the US Family Health Plan family. The Comeauxs, in turn, welcomed baby Asaph into their family. Faith says she is glad the US Family Health Plan supports home birth and midwifery, which she feels is a “lost art.”

“Everyone was very supportive, very encouraging,” she says. “They were willing to go above and beyond to meet my needs as the patient and set forth what would be best for me in my situation.”

 

The Comeauxs have since left New York, as Aris is in Korea for a year-long unaccompanied assignment. Faith has moved with the couple’s five children – three boys and two girls – to Hawaii. There they eagerly await Aris’ return and baby number six, a boy due in March. Ever the planner, Faith will again have a home birth.

“Of course I’m pregnant now, and I looked up US Family Health Plan to see if it was offered here! It would make my life a whole lot easier if it was,” she says. “I can’t stress it enough: it was God working through people that had willing hearts. It was just amazing. They were able to care about the patient more than anything else. I could have been just a number, and they could have said, ‘Nope you’re past due. We can’t help you.’ But they did the exact opposite. That was two years ago and still gives me goosebumps, to be honest.”

Comeaux Crew

NDAA Conference Committee Proposes Military Health Reforms That Highlight US Family Health Plan’s Model of Care

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Congress is one step closer to a makeover of the Military Health System (MHS) and TRICARE that will feature the model of care, values and performance objectives already provided by the US Family Health Plan.

In the recently-passed conference bill and report on the National Defense Authorization Act for Fiscal Year 2017 (NDAA), Congress establishes objectives and expectations for improving military health care beginning in 2018, focusing on quality, value-based care and an improved experience and access to care for beneficiaries. Specifically, in the report Congress calls for the Department of Defense (DOD) to pursue several strategic improvements to military health services, including:

  • Improved access to health care
  • Improved health outcomes
  • Improved quality of health care
  • Enhanced beneficiary experience in receiving health care
  • Lowered per capita costs of health care

Congress urges DOD to focus on value-based reimbursement for the companies that provide care to military beneficiaries and better health outcomes for these patients. The member organizations of the US Family Health Plan Alliance are pleased and encouraged by Congress’ approach to military health care reform because the US Family Health Plan program has consistently provided high quality care, easy access to care, improved health care outcomes, and very high beneficiary satisfaction for many years. We have set and maintained the standard for military health care through a value-based approach to care that continually yields the highest quality and beneficiary satisfaction marks in TRICARE.

As highlighted below, the conference report’s strategy guidance to DOD includes specific goals, which the US Family Health Plan already achieves.

NDAA Conference Report Objective: Value-based incentive programs to shift financial risk to health care providers and managed care support contractors—

The conference agreement between the House and Senate requires the Secretary of Defense to develop and implement value-based incentives as a part of any contract awarded to provide health care to military beneficiaries. Along with these incentives, a new acquisition strategy for managed care is also required

The US Family Health Plan is currently TRICARE’s only value-based, capitated model of health care, and the US Family Health Plan Alliance is gratified that Congress is embracing the value-based model of care. This model of care rewards delivery of appropriate and necessary care, based on the population of patients and their likely medical needs, ensuring that the contractors have the burden of keeping healthy patients healthy and achieving positive health outcomes. As results from the US Family Health Plan have already demonstrated, Congress’ direction to DOD to incorporate value-based care into the managed care support contracts should yield better health outcomes for more patients and cost savings over the long term.

“The US Family Health Plan is the model of care that the Department of Defense should emulate,” said Linda Marzano, chair of the US Family Health Plan Alliance’s board of directors and CEO of Seattle-based Pacific Medical Centers. “This program has consistently provided the high quality care military patients deserve, better health outcomes, high patient satisfaction and at a reasonable cost for taxpayers.”

NDAA Conference Report Objective: Incentives that emphasize disease prevention and wellness and encourage patient participation in medical and lifestyle intervention programs—

The NDAA conference agreement requires DOD to use prevention and wellness incentives to encourage beneficiaries to seek health care services from high-value providers. The bill also requires the use of incentives to encourage certain beneficiaries to engage in medical and lifestyle intervention programs.

As a value-based care program, the US Family Health Plan member organizations already incorporate health prevention, wellness, and disease management programs into the regimen of care afforded to beneficiaries. Through the use of predictive, population-based modeling, specialized care protocols are tailored to the needs of individual patients. This modeling permits better use of preventative and lifestyle management care, especially for those with chronic conditions. We also encourage our members to participate in the management of their own health care, another feature of the US Family Health Plan that other contractors would do well to adopt. Patient participation in their own care ultimately yields improved efficiency, better health outcomes and higher patient satisfaction because they are invested in their own care.

NDAA Conference Report Objective: Maximize flexibility in network design and configuration and develop high-performing networks—

Another positive aspect of the fiscal year 2017 NDAA conference bill is that it encourages partnerships between military treatment facilities and high performance military-civilian integrated health delivery systems. This objective would be accomplished through the use of memoranda of understanding and contracts with local or regional health care delivery systems, including HMOs, health care centers of excellence and other similar organizations.

The member organizations of the US Family Health Plan Alliance commend Congress for directing the Department of Defense to work with high performance health care delivery organizations like us. US Family Health Plan beneficiaries overwhelming report high levels of satisfaction with the care they receive, earning the US Family Health Plan high marks for both quality care and patient satisfaction that outpace the rest of TRICARE and private sector health care. The National Committee for Quality Assurance (NCQA) recently awarded top national ratings to our member organizations, including Johns Hopkins and Martin’s Point Health Care in Maine, both of which earned 5 out of 5 ratings for customer satisfaction, prevention and treatment. These ratings are important because NCQA considers results from the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey. This survey regularly ranks US Family Health Plan among its highest performers. For example, in 2015, CAHPS gave the US Family Health Plan a 91.5 aggregate member satisfaction rating – more than 25 percentage points higher than the national average for commercial health plans.

The bottom line is that the US Family Health Plan program already provides many of the features, benefits and performance objectives that Congress is directing the Department of Defense to pursue. The US Family Health Plan Alliance offers its support for the reforms outlined in the NDAA legislation and is eager to work with Congress and DOD as a partner to improve the Military Health System and improve the health care that our military beneficiaries so richly deserve.

Happy Birthday to the National Guard from the US Family Health Plan

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The US Family Health Plan Alliance wishes the National Guard a Happy Birthday as it celebrates 380 years of service to our country.

The Alliance thanks all current, former and retired National Guard members for their service and sacrifices as they’ve upheld their motto of “Always Ready, Always There” for more than three-and-a-half centuries.

The member organizations of the US Family Health Plan Alliance express our sincere appreciation for the work of the Army and Air National Guard, and we are grateful for the privilege of providing health care to eligible members who receive their health care through the US Family Health Plan.