Engaging Patients in Their Health: HealthPartners

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1 Engaging Patients in Their Health: HealthPartners Too often, people are left on their own to manage an illness. At HealthPartners, the experience is different. HealthPartners health plan proactively reaches out to help and support its members in their efforts to stay or get well. The Problem: Today s predominant fee-forservice system rewards sick care over health care. This results in unmanaged illness and leaves individuals and communities vulnerable to higher costs. The Solution: To boost individual and community health and to lower health care cost trends, HealthPartners has invested in Health & Wellness, a sophisticated system to identify members health status whether they are well, ill or at risk for disease then engage and support enrollees with an array of services and programs that meet individuals wherever they are on the health spectrum. HealthPartners is a Minnesotabased, not-for-profit HMO. It is the largest consumer-governed, nonprofit health care organization in the nation. HealthPartners mission is to improve the health of its members and community. The HealthPartners family of health care companies serves 1.3 million members. Health & Wellness Results: In 2009, disease management efforts prevented more than 1,400 HealthPartners members from having condition-specific events requiring hospitalization such as heart attacks, asthma attacks, out-of-control glycemic episodes and heart failure exacerbations, according to an independent analysis. Members with asthma who were engaged in an asthma control program had 58 percent fewer hospital admissions after participating in the program for at least 6 months. Enrollees who were at very high risk for diabetes and who were enrolled in the plan s wellness program had a 55 percent lower diabetes incidence rate over 30 months of program participation (compared to high-risk patients who had not enrolled). Members in participant-centered health coaching for weight management lost 6.5 pounds on average over the course of the program, while those coached about tobacco cessation showed a 65 percent quit rate at 6 months follow-up. 1

2 ACHP Plans Engage Patients in Their Health ACHP plans are demonstrating that the key to optimal patient outcomes is engaging consumers in their own care and investing in sensible systems of care that revolve around patients needs. The greatest untapped resource in health care is the patient. In their communities, ACHP plans are reworking care delivery by putting a premium on wellness, making it easier for members to stay healthy and helping those with chronic conditions better manage their diseases. Helping people to stay healthy, get well and manage chronic disease improves the health and financial security of individuals and the community. Here are some of the ways ACHP plans are engaging members: Letting patients have a say in their treatment to increase patient satisfaction and lower costs. At Group Health Cooperative in Seattle, doctors use shared decision-making providing information and tools that help patients weigh their options so patients have a say in treatments that fit their lives. Letting patients remotely contact their doctors, get test results, refill medicines and track their health. Group Health Cooperative of South Central Wisconsin engages members through its Web-based MyChart system and through members smart phones via a mobile engagement platform. The Story: HealthPartners Engaging Patients in Their Health Things didn t look good for Clarence Bill Doheny in The truck driver from Belle Plaine, Minnesota, needed an ankle replacement, but a doctor told him it was not advisable at the time. Bill was at risk of losing his foot, as he was overweight and had recently been diagnosed with diabetes. Then he got a call that changed his life. A phone counselor named Theresa from HealthPartners reached out to Bill after a claim review showed he recently had been diagnosed with diabetes. She listened to Bill s dilemma and told him if he got his diabetes under control, he could get his ankle fixed. That got my attention, he says. Theresa worked with Bill to draft a wellness plan in order to help him reach his health goals. She helped alter his diet, encouraged him to exercise and told him it was important that he take his pills for diabetes. I started going to a fitness center, he says. I couldn t walk, but she suggested trying the recumbent bike. That worked well. Theresa gave him pointers, telling him he could still eat his beloved ice cream, just not as often, and encouraging him to substitute fruit for desserts. She worked with me, Bill says. I lost 60 pounds, and I got my ankle replaced. It was the best thing I did in my life. Bill says he owes it all to Theresa. Her calling every four to five weeks was quite a stimulus to keep me going. Proactive phone counseling and coaching is just one way HealthPartners engages and supports members in their health. The plan has many ways to engage members including telephone coaching, text messaging, financial incentives and benefit designs whether members have a chronic illness, are susceptible to disease or are currently healthy and want to stay that way. 2

3 ACHP Plans Engage Patients in Their Health Reducing the rate of preventable hospital readmission. UPMC Health Plan in Pittsburgh is teaming with local hospitals to rework the hospital discharge process, improving communication, education and supports so patients get better care to prevent an unnecessary readmission. Putting a greater emphasis on prevention and wellness. Fallon Community Health Plan in Massachusetts gives families in its commercial plan $400 to use toward fitness or health-related expenses. Enabling patients 24/7 access to their care teams through sameday office visits, phone visits and e- mail from home. Group Health Cooperative in Seattle and Kaiser Permanente are broadening access to deliver optimal care. Member Engagement and Support Are Vital to Health Engaging patients is hard for most health plans in today s fragmented, fee-for-service health care system. But HealthPartners and other ACHP members are showing it can be done and done well. Along the way, such efforts are helping to make individuals and communities healthier. HealthPartners stands out when it comes to reaching out and supporting members like Bill in their efforts to be well. HealthPartners offers a variety of approaches via its Health & Wellness program to engage members, including online tools and programs; fitness offerings; preventive outreach reminders for screenings; discounts on exercise equipment and programs; use of premium discounts and financial rewards; phone coaching for smoking cessation, weight management and other health concerns; on-site workplace screenings and more than 20 intensive disease and case management programs. We are a not-for-profit organization with a consumer board, says Babette Apland, HealthPartners senior vice president of health and care management. As a result, our focus is on how we can support our members in empowering health and having an exceptional experience, as well as managing total costs. To do this, HealthPartners has invested in systems of care revolving around members. HealthPartners has an impressive portfolio of comprehensive and integrated health, wellness, and disease and care management programs and services, which is available to its 1.3 million members. But just offering programs is not enough. Engaging members in their health requires outreach and support. Plan investments in fully integrated systems, processes and information platforms help ensure that members receive all the services they need to achieve their optimal health goals. HealthPartners patient registry provides health coaches with access to each member s detailed health and program information, providing the full picture they need to refer members to appropriate 3

4 programs But it is the ability to reach out, engage and support members that makes the data and referral process meaningful. Highly skilled health coaches are at the heart of the plan s member outreach and engagement. All health coaches have completed extensive training in intrinsic coaching and shared decision making. These coaching approaches are centered on the whole person, taking into account what is most important to the member. This allows the member and coach to work together to set and accomplish meaningful goals. When specialized support is needed, the coaches quickly refer members to their lifestyle behavior coach specialists through HealthPartners Connect the centralized point of contact for all health and medical management program referrals. This ensures that a member s health and wellness needs are fully integrated. HealthPartners Connect is staffed by experienced nurses who use clinical, program and benefit eligibility knowledge to evaluate and seamlessly triage referrals to the appropriate program area. Processes and workflows are in place to receive referrals via an intake phone line, fax, or secure mobile phone messaging. All identified members receive outreach. Making Health Care Affordable As HealthPartners sees it, engaging members in their health and providing supports for them to get and stay well reduces future claims, a key to saving money in the long run. Realizing engagement and support is not a one-size-fits-all approach, HealthPartners uses a wide range of tactics to meet an individual s needs. It s about figuring out where individuals are in their personal health journey and then to support and facilitate health improvement from that point forward, says Nico Pronk, HealthPartners vice president of health management. HealthPartners is also adept at customizing health and wellness offerings to match an organization s culture. That outreach and support and versatility is a big reason Star Tribune Media Company in 2007 chose HealthPartners as its only health plan. HealthPartners has been a very good partner, says Adrienne Sirany, vice president for human resources for Star Tribune. Consolidating its health benefits and health and wellness offerings with HealthPartners made sense for the company and its 1,100 workers. We like their programs and approach, she says. It makes it easier to engage people. That engagement and support of its workers allowed Star Tribune to save nearly $500,000 in 2009 by managing diseases, a three-to-one return on its investment. The plan s ability to engage its members has produced impressive results across the board. In fact, Alfred Lewis, president of the national Disease Management Purchasing Consortium widely credited with inventing disease management 4

5 said HealthPartners disease management performance between 2001 and 2009 was the best performance of any health plan that it tracks. Supporting our population in staying healthy improves well-being and quality of life for our members and helps manage the affordability of health care, Babette Apland says. The Alliance of Community Health Plans (ACHP) brings together innovative health plans and provider organizations that are among America s best at delivering affordable, high-quality coverage and care to their communities. Drawing on years of experience, members collaborate to identify problems, share information and work toward solutions to some of health care s biggest challenges. Their work is the foundation for ACHP s advocacy on behalf of better health care nationally. 5