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Two experts discuss top-of-mind women’s healthcare issues in managed care.
In this Q&A with Managed Healthcare Executive(MHE), Susan Robertson, MD, a practicing primary care physician at Broomfield Family Practice, in Broomfield, Colorado, and Barbara Nabrit-Stephens, MD, MBA, FAAP, medical director at Health Integrated, discuss how managed care organizations can improve women’s health, help control Zika, and address the rise of consumerism.
RobertsonRobertson: One of the biggest drivers in women’s health right now is the industry’s push toward wellness/preventive medicine. Requiring payers to cover aspects of women’s wellness visits, including Pap tests, mammograms, birth control, osteoporosis screenings, immunizations, etc., has increased positive utilization as well as access to women’s healthcare.
Additionally, these visits are helping providers identify conditions such as cardiovascular disease in women. In Colorado, we have seen a dramatic reduction in teenage pregnancy due to increased access and no cost for birth control and intrauterine devices.
Our MCO, Physician Health Partners (PHP), focuses on two areas to improve adherence to annual wellness visits (AWVs) among women: provider adherence and patient education.
For providers, we focus on education around the importance of AWVs and the benefits of thorough and complete wellness visits. If the provider completes a thorough AWV, it can result in:
• Identifying other behavioral or physical needs of the patient, resulting in early diagnosis, education opportunities, and preventive measures;
• Documenting all diagnoses properly;
• Achieving quality measures;
• Providing more patient-centered care; and
• Enhancing patient engagement in their health.
PHP helps providers with AWV action plans, patient intake and follow-up templates, and resources to provide to patients once any issues are identified, such as behavioral health, chronic conditions, or social needs.
For patients, PHP focuses on patient outreach and care coordination to help educate about the importance of annual wellness visits. This outreach includes mail, telephonic, and face-to-face education. PHP has a team of clinical social workers and nurses who provide patient outreach and education via home visits, facility visits, or practice colocation.
One downside for patients as they come in for AWVs is when we find something that requires follow-up or treatment. This can lead to costs for the patient. For example, if we have a patient who has an irregular mammogram and we refer them for an ultrasound, they are now responsible for out-of-pocket costs (based on their coverage). This may deter them from seeking the care they need in the future.
Nabrit-StephensNabrit-Stephens: One way MCOs could be a more positive influence on women’s health would be to decrease the number of prior authorizations needed to cover services. For example, not requiring prior authorization for a mammogram for a woman who fits the nationally accepted screening guidelines. Another would be making contraceptives available without prior authorization.
MCOs could also be more prompt in providing preventive health information to women. Guidelines change all the time but most MCOs only distribute quarterly member newsletters. Disseminating updates sooner would be very helpful.
Robertson: From an MCO perspective, as well as a physician perspective, we are really utilizing information from the health department and the CDC to educate patients and understand the risks. My advice to patients who are pregnant or thinking of becoming pregnant is to avoid areas at high risk of Zika and to avoid having intercourse with males who have been in high risk areas recently and could be carrying Zika. With the heightened awareness of Zika and its effects, we are seeing more questions about it.
Nabrit-Stephens: Providers should have the most current information and be conveying it to their patients. It’s a rapidly evolving subject, so it’s challenging for MCOs to keep their websites updated with the latest news. But this question raises the greater issue of the role MCOs can play in pre-conceptual health. There is a lot of opportunity for MCOs to provide better information on such pre-conceptual health topics as nutrition, vaccinations, the effects of alcohol, tobacco and certain drugs, and much more.
Robertson: We are seeing a push to more consumer-driven healthcare, but a lot of the tools still aren’t where they need to be for people to make informed decisions. We also find that when it comes to healthcare, the quality is as much of a factor, if not more so, than cost. For example, when it comes time for a woman to choose a physician to provide OB/GYN services and a hospital to deliver her child, cost is usually a secondary motivator. Women now are turning to the Internet for online reviews, ratings, and recommendations from other consumers.
Additionally, many cost analysis databases fail to report on quality of the provider/facility/care received and focus only on cost. This doesn’t give consumers all the tools they need to make decisions about their healthcare.
Consumer health literacy is another factor that drives consumerism. The information may be there, but that doesn’t mean it’s easy to find or understand. Health plans are also starting to provide more cost and quality data to their members, but that information is not always up-to-date or accurate and relies on claims data that often are not available in real-time.
Nabrit-Stephens: New consumerism is displayed in both males and females. Today’s population is much more informed than its counterparts of the early 2000s. Millennials are demanding responses to findings they have uncovered on the Internet. They are making medical decisions based on online research. There is a new level of expectation that has them questioning the need for and potential long-term complications and cost of provider recommended treatments.
They also don’t see the need to be seen at physician offices. They want to text or video conference with providers. The healthcare industry is responding with remote biometric monitoring devices, telehealth consultations, apps and other means to meet consumer demands.
Tracey Walker is content manager for Managed Healthcare Executive.