COLUMBUS, Ohio, Oct. 5 /PRNewswire/ -- With runaway healthcare costs forcing more employers to reduce health insurance benefits or layoff employees, a new model of healthcare is emerging in Ohio that has held healthcare cost increases to one-third the national average. Quantum Health announced today that its innovative Community Coordinated Healthcare program saved participating employers more than $13 million during the past year.
“We’re extremely pleased with these results,” says Kara Trott, president of Quantum Health. “These savings show that by working in cooperation with physicians, and helping them help their patients -- rather than dictating to them how to practice medicine -- the healthcare process can be better coordinated and costs can be reduced.”
Trott, who has a background in market analysis and strategic planning, said Community Coordinated Healthcare grew out of patient and physician research in selected healthcare markets in the 1990s. “We worked closely with physicians in these communities, and interviewed more than 3,200 patients, and found that there are critical gaps in the ‘process of healthcare’ that lead to unnecessary cost and delays in treatment,” she said.
The research identified specific actions that could be taken to assist physicians in guiding patients through what Trott calls the “fragmented maze of healthcare,” reducing or eliminating unnecessary services and speeding the process of diagnosis and treatment. Trott said the research and resulting business model suggest that 18-20% of healthcare services never needed to occur, and can be reduced or eliminated through coordinating the “process of healthcare.”
Community Coordinated Healthcare accomplishes this through a staff of Care Coordinators who advocate for patients and assist physicians and their office staff in guiding patients through the confusing healthcare process. Patients and their families receive guidance, information and support, while the program reduces duplicate procedures and unnecessary delays.
Trott gave numerous concrete examples of healthcare that is not coordinated:
* A woman who spent seven days in the hospital after breaking a hip and being told she needed an angiogram as a precaution before she could have hip surgery. Her family was left in the dark as she waited four days and was transported to another hospital with the angiogram lab, then a nurse walked in, gave her a $200 walker, and said she could go home. Subsequent inquiries revealed that the orthopedic surgeon and cardiologist had mis-communicated for several days, and by the time the angiogram got scheduled, her hip bones stitched and surgery was no longer possible. * Another cardiologist sent his patient to a larger hospital to immediately receive coronary bypass surgery, but his patient lay there for six days before surgery -- unbeknownst to the home cardiologist. The hospital staff had trouble arranging for the patient’s diagnostic reports to be sent from the first hospital, causing the delay. * A patient contacted by Care Coordinators three days after discharge from a hospital reported that a specialist physician had ordered an MRI for him the next day, and he dreaded getting back into the car and “being stuffed into that machine” while he was recovering from surgery. The Care Coordinators contacted the physician and alerted him that another specialist had just ordered an MRI four days earlier. They arranged for the MRI results to be sent to the second specialist, and the second MRI was unnecessary -- saving about $2,000 and preventing further discomfort for the patient.
Most of these examples met the standardized clinical criteria used nationally by health plans to screen such procedures for medical appropriateness, Trott said. “They all represent healthcare that is clinically appropriate, but not well coordinated. When one physician doesn’t know what the other one knows or has done, procedures get duplicated and unnecessary delays occur. Patients don’t know the right questions to ask, and physicians don’t have the staff to track down the information or diagnostic results, so they repeat them.”
“We like to say that good healthcare requires more than good medicine,” Trott said. “It takes a staff of professionals who can help the physicians and their office staff in the coordination of their patient’s care. The traditional insurance company approach in this country is to tell doctors how to more appropriately treat their patients. Our program shows that instead, you just need to help the physicians in the course of care they prescribe.”
“It’s really amazing how much opportunity there is to generate real savings by better coordinating healthcare activities,” Trott said. “When patients are left completely without guidance, healthcare becomes a ‘maze’ of providers and facilities that don’t seem to be communicating with each other or sharing test results. If you’ve ever had a loved one in the hospital, you’ve probably asked ‘when is the doctor coming to give us some information,’ and been told, ‘I don’t know, maybe in the morning.’”
Community Coordinated Healthcare is often operated through community provider networks that are partially owned by local physicians and the community hospital. Quantum Health reports that more than 350 physician-owners participate in this model.
Community Coordinated Healthcare has currently been applied only to employer health plans that are self-insured, meaning the employer pays directly for the basic medical costs of its employees and their dependents -- up to a certain “stop-loss” ceiling, after which an insurance company assumes the costs. About one-third of employees covered by an employer health plan -- or 55 million Americans -- are covered through such self-insured benefit plans.
While the Care Coordinators form the “center core” of the patient-physician assistance program, Trott said that Community Coordinated Healthcare also depends on specialized benefit designs, patient education, and wellness and disease management program to achieve its results.
Another large cost factor addressed by Community Coordinated Healthcare is inappropriate self-referrals to specialists. Quantum Health’s research showed that as much as 41% of specialist visits are “self-referred,” and approximately 60% of these wind up being to the wrong type of specialist. Trott said these “wrong turns in the healthcare process” result in an average 5.5 visits over 11 months with more than $1,500 in diagnostic services, before the patient is told that the specialist can’t help them.
“There is a real power to having your care coordinated by a primary care physician,” she said. “Studies have shown that the vast majority of patients prefer to have their care coordinated by such a physician, but they don’t want their freedom or choices restricted. Community Coordinated Healthcare provides voluntary incentives to utilize a coordinating physician, but patients are free to do as they choose. We then use education and patient advocacy to encourage patients to begin all healthcare events with a call or visit to their coordinating physician.”
Overall, employer groups using Community Coordinated Healthcare have seen their employees’ use of primary care physicians increase by nearly 30%.
“We think that channeling patients through primary care coordination is very critical. In our employer groups, there is a corresponding decrease in specialist usage by some 14%, a decrease in Emergency Room usage of 16%, and a decrease in prescriptions of 11%.”
Community Coordinated Healthcare differs from other healthcare programs in several ways. HMOs and managed care programs utilize a two-pronged approach to cost control: using the leverage of their large enrollee base to negotiate lower fee structures with doctors, and conducting prior screening of referrals and procedures that doctors recommend. That industry model, according to Trott, incorrectly places all the industry’s problems on the shoulders of physicians, based on the premise that they are charging too much and not doing the right things. “Our model concentrates on reducing the confusion and inefficiency that is inevitable in healthcare, which is a fragmented system of independent providers. “
About Community Coordinated Healthcare
Community Coordinated Healthcare, offered by Columbus, Ohio-based Quantum Health LLC, is an important response to today’s runaway healthcare costs and increasing patient dissatisfaction. The program achieves superior cost control through a staff of highly effective care coordinators who advocate for patients and assist physicians and their office staffs in guiding patients through the confusing healthcare process. Over the past five years, the program has held participating employers’ annual cost increases to just 5-6%, one-third the national average.
To learn more about Community Coordinated Healthcare or Quantum Health, visit http://www.quantumhealthllc.com/ or contact Randy Gebhardt, Chief Operating Officer at (614) 846-4318, ext. 141.
Quantum Health LLC
CONTACT: Randy Gebhardt, Chief Operating Officer of Quantum Health LLC,+1-614-846-4318, ext. 141
Web site: http://www.quantumhealthllc.com/
