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AHIP 2017: SummaCare exec shares their best practices for patient care outreach.
With the number of quality initiatives being undertaken by healthcare providers and payers, it’s difficult to assess the impact of that follow-up outreach on patients. One easy to way to define that follow-up outreach? Patients getting as many as 25 phone calls to check on their health status or for medication reconciliation.
That’s precisely the problem that Charles Zonfa, MD, chief medical officer at SummaCare, had to solve among Medicare Advantage beneficiaries, he said in his June 9 presentation at America's Health Insurance Plans (AHIP) Institute & Expo 2017 Institute & Expo, in Austin, Texas.
Those duplicative calls used to come from SummaCare, the payer part of the organization, in addition to calls from clinicians at SummaHealth, the large, integrated healthcare system under which SummaCare functions. That’s in addition to check-in calls from the healthcare system’s ACO and even from independent, community physicians’ offices that are affiliated with the health system.
This was very confusing from the patient’s perspective, he noted. “Imagine that you’re a patient who has SummaCare as your insurance payer, and you’re in the hospital and somebody meets with you and says, ‘We’re going to call you after you’re discharged and make sure that you’re feeling well and address any concerns you have regarding your health.’”
The problem was the phone calls never stopped, said Zonfa.
“Anecdotally, what we heard from patients was, ‘I’m trying to recover, and I’m answering the phone all day…and I can’t rest,’” he said. Patients were getting calls from as many as 25 people, all offering them the same thing.
Zonfa has focused his efforts on driving a quality agenda in addition to fixing how the entire healthcare organization is integrating care delivery in a way that is “streamlined and invisible to our Medicare Advantage members,” he told Managed Healthcare Executive (MHE).
“I’m not concerned that when there’s outreach done that it’s coming from the health plan, as long as the objective is making sure the patient has the support they need and has their questions answered when they get home,” he told MHE.
What matters, said Zonfa, is patients have a case manager who can help get them appointments with their doctor and that someone makes sure that their list of medications is correct and that patients aren’t duplicating like-sounding medications.
In her presentation during the same session on payer-provider collaboration, Mara McDermott, vice president of federal affairs at CAPG, a trade association for physician organizations around the country, had some encouragement for payers and providers working together in value-based care.
“This requires that you make some pretty significant changes to your business. That’s true on the physician side and it’s also true on the plan side. The biggest thing is to take a leap away from the old way to the new way,” she told MHE.
Many of the groups CAPG works with are in California, and they’ve been involved in value-based care for 30 years. But she’s also seeing success in other areas of the country, such as in Rhode Island. “Value-based care is working. That’s the most important point for physicians to understand….It’s not as scary as people thought,” she said.