Population health management (PHM) has the potential to improve health outcomes, increase general wellness and lower costs, but most of the programs are still at the theoretical stage. Working in conjunction with the local plant of a major manufacturing company, Blanchard Valley Health System put those theories into practice, creating an ambitious PHM initiative that included building a patient registry for the company’s employees and dependents in the company’s health benefit plan, developing a Nurse Care Navigator program to provide interventions for employees and dependents with chronic conditions such as diabetes and making it easy for outside physician practices to participate in this program. Blanchard’s PHM initiative generated measurable positive results across several populations.
The local manufacturing plant and Blanchard Valley Health Systems had teamed up in the past to develop a value-based benefits program designed to get employees and dependents in the company’s health benefits plan to be more actively involved in their own care. So when the company decided to launch a PHM initiative to see if it would help improve employee health, wellness and productivity, especially around chronic diseases such as diabetes, congestive heart failure and COPD while lowering its overall health care costs, naturally Blanchard was its first choice. For its part, Blanchard saw an opportunity to transform the delivery of care within the entire system by creating a medical home program that was patient-centric and based on improving the quality of life rather than merely treating acute health problems as they occurred. If successful, it could serve as a model for care delivery for the future for other employers in the Findlay area. The program was launched January 1, 2010.
Knowing that claims data would be insufficient for PHM, Blanchard implemented a comprehensive patient registry technology that would capture the history of care, results and date for each intervention and allow it to be shared by the hospital and all 14 outside physician offices. The registry could then be used to generate alerts regarding patients who were due (or overdue) for an office visit, identify evidence-based guidelines for each patient, and fill gaps in care. For example, it could be used to generate reminders that patients were due for a mammogram or colonoscopy, or to remind doctors to suggest TDaP immunizations to adults who will be in contact with babies.
To further extend the PHM concept, Blanchard also instituted a Nurse Care Navigation program in 2011 to provide more personalized interventions. For the pilot, Nurse Care Navigators were embedded in the two largest physicians’ offices, which served half of the total enrollees. They used the patient registry to review the records of the most complex, at-risk patients who had COPD, CHF, diabetes and other long-term, chronic conditions as well as those whose history showed frequent visits to the ER. They also work with any patients transitioning from the hospital or a nursing home to community-based care.
For each of these patients, the Nurse Care Navigators worked with physicians, pharmacists and other team members to coordinate care. They attend office visits, then follow-up to ensure the patients were prepared to become engaged in their own care, and had access to the information and services they needed. For example, they call diabetes patients every week, or even every few days if needed, to keep patients on track with the program. In some cases, Nurse Care Navigators went to patients’ homes to help them with medications. If a patient couldn’t afford a medication that had been prescribed, the Nurse Care Navigator would work with the physician, pharmacist and benefit plan to determine an alternative that would work clinically while being affordable. The company was already committed to the concept that a small investment today would save tremendously over the cost of eye, foot or heart problems later if the condition was allowed to go unchecked.
The Blanchard PHM initiative was offered as an option to all of the company’s employees and their dependents in the health benefits plan, roughly half of whom participate. Shortly after launching the program, Blanchard liked the results it was generating so much that it made it available through its own employee health plan.
Blanchard Valley Health Systems was able to generate meaningful results across several populations. Some examples are:
For the TDaP immunization program, prior to the launch of the PHM initiative only 188 of 2,950 eligible enrollees had been immunized. Today, between the company and Blanchard that number has risen to 1,325 – just under 45 percent.
The percentage of women age 40-69 who have had mammograms within the recommended two-year period has also risen. For the company’s enrollees, the numbers have increased from 76 to 83 percent. For Blanchard the number has increased from 63 to 75 percent. For comparison, the HEDIS PPO Commercial Rate in 2012 was 66.5 percent.
The percentage of enrollees age 50-75 who have had a colonoscopy in the last 10 years has also risen sharply. Prior to the PHM initiative, only 60 percent of the company’s enrollees and 42 percent of Blanchard enrollees had had a screening. Today, 70 percent of the company’s enrollees and 59 percent of Blanchard enrollees have been screened. Again, the HEDIS PPO Commercial Rate was 55.3 percent in 2012.
At the start of the Nurse Care Navigation program, 58 complex cases of diabetes were identified, with average HbA1c level of 8.33. Of those, 32 had A1c levels greater than eight (average reading 9.87) and 21 had A1c levels greater than nine (average reading 10.60). When measured in January 2014, readings for the overall diabetes population were reduced to an average of 7.72, a 7.3 percent improvement. Patients with A1c levels greater than eight at the start came down to 8.32, a 15.7 percent improvement. Those with levels greater than nine at the start came down to 8.67, an 18.2 percent improvement.
Financially, after its first full year of serving patients, the Nurse Care Navigation program had a return of $2.44 for every dollar invested in the program.