Collaborating with Insurance Companies to Improve Person-Centered Care

The Problem:

The complexity of healthcare and the breadth of the continuum of care often means that patient hand-offs in transition from different care providers is both inefficiently structured and overly burdensome to the patient. 

The Goal:

Palmetto Health and BlueCross BlueShield (BCBS) wanted to integrate their case management practices to reduce duplicative efforts and provide better, more patient-centered care. 

Method & Implementation:

Palmetto Health has provided high-intensity case management to their high-risk population through it’s ACTT (Ambulatory Care Transitions Team) and PACTT (Pediatric Ambulatory Care Transitions Team). These case managers go into their community to provide hands-on case management until patients reach their care plan goals (usually 30-45 days). At the same time, BCBS also has case managers tracking their beneficiaries by telephone, but with no coordination with the hospital’s efforts. 

Instead of working in silos, the two groups of case managers now coordinate care. ACTT and PACTT teams will follow the patient until the patient’s care goals.  The teams communicate with their patients about how the hand-off to BCBSSC will work and that BCBSSC case managers will continue to be a resource after the more intensive hospital team case management is competed.  At completion of their program, Palmetto Health share specific reports to BCBS case managers to facilitate the transition of care. Leaders of each division of case management meet every two weeks to discuss current status and barriers for the most challenging patients. The insurance company benefits from the relationship and work already established by the hospital while reducing redundancies, while the patients get the benefit of a more streamlined, easy-to-understand care system because of the coordination efforts. The hospital’s case management also get valuable assistance in better identifying resources to meet the patient's needs, while the insurance company leverages the increased trust of the hospital-patient relationship.  

Above all, the approach allows a system of care that considers the patient holistically and closes not only healthcare gaps, but also determines other healthcare needs that may be barriers to care, from navigating the health system and utilizing community resources to reducing pharmacy costs and copays.

Results:

The ACTT program has aided in keeping 964 patients (94.88%) from having a hospital re-admission within 30 days of their hospital discharge in the fiscal year to date (June 2018).

For more information about this story or to tell us about your own best practices, email us at stories@scha.org.

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