Fix for America's health system: new model of care
The fix for America’s broken health care system is to develop a new model of care – one that reduces fragmentation and duplication, and that places an emphasis on wellness and prevention. This is because most health care costs are tied to chronic illness and the complications, and potentially avoidable emergency room visits and hospitalizations that result from them.
Enter Coventry Advantra® Total Care. Via Christi Health, in collaboration with Coventry Health Care, Inc., has spent more than a year piloting the new Medicare Advantage product for which Sedgwick County residents may enroll.
Via Christi Health primary care physicians offices serve as a “medical home” for Medicare patients who receive initial screenings that can determine whether they have chronic health issues, such as diabetes, that require long-term management.
Among eight Medicare health plans with drug coverage listed on Medicare.gov, Advantra Total Care is the highest ranked plan. It also has the lowest estimated annual health and drug costs among the plans.
Advantra Total Care has no copays for primary care visits, lower out-of-pocket expenses and includes medical, vision and dental care.
The cost of chronic illness
Ed Hett, MD, is a family physician and president of Via Christi Clinic.
“The basic state of health care that we’re treating now is one with chronic disease and that is very different than treating acute illness,” such as pneumonia, which, Hett explains, a patient can recover from in about six weeks. “If you have a chronic disease such as congestive heart failure, rheumatoid arthritis … you’re not talking about six weeks, you’re talking about decades.”
According to the Centers for Disease Control, more than 75 percent of America’s health care costs are due to chronic conditions.
The typical hospital stay, for example, costs $20,000, but it can be avoided through a visit to the doctor’s office or a routine screening.
“A $2,000 colonoscopy could save you $100,000 in cancer therapy,” says Hett, adding that a precancerous polyp can be removed, sparing a patient hospitalization, surgical intervention, chemotherapy and radiation therapy for a cancer that has progressed from a polyp.
Jacques Blackman, MD, a family physician with Via Christi Clinic, participated in the pilot for Advantra Total Care and gave valuable input into the product’s final model.
“It seems like a better way to take care of people,” he says. “And, it does seem like a model that we can use in the future for more people and have better quality outcomes.”
Looking Out for the Patient
One of Blackman’s favorite features of Advantra Total Care is the navigator – a medically trained individual who tracks patients throughout the health care system and keeps the primary care physician informed about their treatment.
“I know that when they make an appointment to see me after they’ve been in the hospital that we have their data and the patient knows that they are supposed to come in,” he says.
Ashli Benjamin, a physician assistant with Via Christi Clinic, serves as navigator for the Total Care program.
“The biggest thing that I have discovered is that most patients who are discharged from the hospital fail to make their follow-up appointment with their primary care physician, even though it’s on every discharge summary,” she says, adding that patients who visit the emergency room are even less inclined to schedule follow-up visits.
So, Benjamin works through physicians’ offices to get follow-up appointments scheduled, and cooperation from patients has been very good. Total Care also addresses such needs or barriers to care as transportation and patient education by connecting patients to resources.
In the pilot project for Total Care, Benjamin says, the product is meeting the goal for decreasing the number of inpatient hospital admissions. Getting people to switch from using the emergency room for primary care has been more challenging. But, Benjamin reports successes with two recent patients, one of whom had been to the ER three times, and the other seven. The first hasn’t been back at all and the second hasn’t been back in two months.
Perhaps most important of all, patients appreciate the Total Care approach, says Blackman.
“Patients feel as if they are part of a different [health care] system. It seems as if there is someone looking out for them with this product.”
A Coordinated Care plan with a Medicare Advantage contract. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013. Medicare beneficiaries may enroll in Coventry through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.