Most everyone can agree we need to improve health care quality, reduce costs and move from an outdated model of sick care to well care. But how can this be accomplished efficiently and effectively? What’s needed is collaboration.
That’s why Aurora Health Care and Anthem Blue Cross and Blue Shield are working together through a 50-50 joint venture called Wisconsin Collaborative Insurance Company and its Well Priority product to:
- improve value, efficiency and usability of health care services,
- reduce costs by keeping people healthier,
- engage patients in their health care.
You may wonder why a health care system and an insurance company would collaborate in such an integrated way. The short answer: They have common objectives and share a vision of creating an improved health care experience.
Both organizations believe health care quality can improve while costs decrease by using a multifaceted, collaborative approach.
Tapping technology to improve health
The use of data mining technologies in health care can benefit everyone—from health care organizations to insurers to patients.
Aurora’s electronic medical records (EMRs) allow Aurora doctors, hospitals and other health care providers to access a patient’s entire medical record, rather than just a snapshot overview from a current visit. EMRs make it easier to follow up with patients and track ongoing care. They also help maintain clear communication among providers, avoid duplication of services and streamline medical care.
Working together, health systems and health insurance companies can analyze clinical data and claims data to identify high-risk patients and those struggling with chronic disease. Proactive steps can be taken to help those people stay healthy and avoid hospitalization.
Data analysis can document when appropriate medical interventions are being followed and encourages patient compliance. Analyzing claims data for prescription drug compliance is a good example of this.
Reducing prescription nonadherence
Studies show that up to 40 percent of prescriptions written are never filled. This includes vital medications designed to cure disease or prevent medical conditions from getting worse.
Without having comprehensive data, physicians previously had no way of knowing when prescriptions they wrote went unfilled. This nonadherence negatively affects a patient’s health outcome.
So why wouldn’t a chronically ill patient fill an important prescription for a heart medication? There are a number of factors, including low health care literacy, transportation issues, financial constraints and other social factors. These known barriers interfere with compliance to doctors’ orders.
The combination of clinical data and claims data can now be used to better understand what’s going on in a patient’s health and to identify care needs.
Encouraging self-maintenance
Improving outcomes for patients with chronic diseases—those who account for most health care spending—takes time and effort. Medical outcomes are shown to improve through impactful interventions, such as follow-up phone calls and reminders to patients, supportive services to address any social barriers and ongoing patient education.
By taking time to educate patients about their disease and risk factors, providers and insurers can ensure patients truly understand their treatment plan and are following key instructions.
Coordinated care takes a team effort
Coordinated care encourages patients to fully engage in their own health care. Creating a personalized, high-touch patient experience and using a team approach can address any gaps in care. Coordinated care helps foster successful patient relationships by using:
- nurse navigators,
- care coordinators,
- pharmacists,
- social work and behavioral health specialists,
- 24/7 nurse line and online tele-health services.
Another effective way to help people maximize their health is through wellness programs.
All of these patient-centered approaches can significantly improve disease outcomes and enhance the overall health of patients served.
Moving forward
Encouraging meaningful collaboration between medical providers and insurers is a relatively new concept, but one that’s gaining traction. A growing number of health care organizations and insurance carriers are forging strategic collaborations and partnerships, both in Wisconsin and across the country.
To succeed long-term, these collaborative models must always keep the best interests of patients at the forefront—finding new ways for them to become healthier (and enjoy greater patient satisfaction) while reducing the cost of their care.
