Coventry Advantra® Total Care


In the early days of aviation, pilots also served as their own navigators. In this photo illustration, Ashli Benjamin, a Via Christi health care navigator, dons the garb of a swashbuckling aviator and poses next to Dwayne Clemens’ vintage Stearman biplane at Stearman Field in Benton, Kan.


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A new day dawns in health care

Introducing your patient navigator

Patients may never see Ashli Benjamin, a physician assistant, yet she plays a critical role in a new model of health care. She’s called a patient navigator — a term we’ll hear much more about in the future.

Over the past 20 months, Benjamin and her assistant have learned some important things about how patients interact with the health care system and how to improve their care and outcomes.

“In general, everybody wants to be a good patient, but sometimes real life doesn’t allow that to happen,” she says.

This is why the pair daily covers a list of items they do for patients enrolled in the Coventry Advantra® Total Care program. The Medicare Advantage product focuses on caring for patients in a primary care medical home where chronic conditions such as diabetes are identified early and managed to reduce avoidable emergency room visits and hospitalizations. Via Christi family physicians provide the medical homes for the program.

“It doesn’t take many hospitalizations to save thousands and thousands and thousands of dollars,” says Jacques Blackman, MD, a family physician with Via Christi Clinic and a prime proponent of Total Care.

In short, a patient navigator makes sure that patients are where they are supposed to be, their medical records are there when they arrive and the doctor is prepared to see them. Sounds simple, but it isn’t, as Blackman explained to those attending the recent Wichita Business Coalition on Health Care’s Innovation Summit.

“This morning, I got two emails from Ashli about two of my patients who had been in the hospital,” he explained. “I can’t do much to care for patients if I don’t know they are there.”

Nor can he do much if the patients are discharged from the hospital with instructions to see their family physician, but never make an appointment. On average, only 44 percent of patients see their doctor after a hospital stay. By contrast, 67 percent of Benjamin’s patients make follow-up appointments with their physicians.

The Total Care program began as a pilot and has since grown to cover 1,000 Medicare patients. The use of navigators such as Benjamin is a central element of new care models being designed by Via Christi to provide patients higher-quality, better-coordinated care at a lower cost.

Helping patients make and keep appointments is the greatest success Benjamin has had as a navigator, whether it is for a regular doctor’s visit or to see their family physician after a hospital stay or emergency room visit. Benjamin’s work has paid off in reduced hospitalizations and ER visits for patients in the Total Care program.

“We go through and check out all appointments for our patient group, those that have been completed and those that have been cancelled,” she says. “We figure out why and whether they need to be rescheduled.”

They track patients’ future needs for lab work, mammograms and just regular appointments. They even have a file for patients who are supposed to return to the doctor in three months.

They also track quality improvement measures, many of which involve whether patients have had screenings such as mammograms or spirometry for chronic obstructive pulmonary disease and which patients still need a screening every few years. Then they set up the appointments.

All of this is done through the family physician’s office so the medical home is aware of what they are doing for patients.

“Patients probably aren’t aware of everything that we do,” says Benjamin. “We try really hard not to have navigation be a different resource. We want it to be an extension of the patient’s doctor’s office.”

Even when a patient has been to the ER, Benjamin and her assistant are aware and let the doctor know within 24 hours.

“At least within our Total Care population, there’s none of this, ‘the patient shows up and the doctor has no idea why you’re here’ because you were in the ER,” she says. “The doctor already has those ER records available. It saves doctor time and patient time as well.”

And there is more than just scheduling appointments and health screenings that helps patients enrolled in Total Care.

“I’ve learned that there are a lot of nonmedical barriers that keep patients from getting good medical treatment,” says Benjamin. “Sometimes it’s transportation. Sometimes it’s a financial barrier. Sometimes it’s a safety barrier in the home.”

It can be a medical barrier, such as depression, that ultimately affects the outcome of treatment for diabetes or other chronic conditions. Having Benjamin and her assistant get to know patients on an individual level, and learn about and help remove barriers, has improved patient outcomes.

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.

Call 866-823-1990 to sign up for Advantra® Total Care

 

 

 
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