What is care coordination?
“Care coordination” means the way in which primary care physicians, specialists, hospitals, etc., meet a patient’s needs and preferences for health services, and how they share information among all the parties involved.
Coordination makes high-quality health care outcomes possible, as it greatly increases efficiency and safety. There are two types of care coordination: provider-provider coordination (interactions among different care providers) and provider-family coordination (interactions between providers and patients and their families).
For example, 5% of primary care visits result in a specialty referral, 71% involve a prescription, 36% a laboratory test and 13% an imaging study – all these situations require care coordination.[Source]
How do we know improvement is needed?
Here are some statistics that help explain the situation. While these are national figures, they are representative of what we face here in Western New York.
- 69% of primary care physicians reported sending a patient's history and reason for consultation to specialists, but only 35% of specialists said they received such notification.[Source]
- 81% of specialists said they send consultation results to the referring primary care physician, but only 62% said they received such information. [Source]
- 23% of respondents with chronic conditions saw four or more doctors over the last year.[Source]
- The typical primary care doctor has the potential to interact with as many as 229 other doctors in 117 different practices. [Source]
- 1/3 of adults say the health care system is poorly organized.[Source]
What problems result from this?
Duplicate tests. Hassles getting test results back. Errors. Overtreatment. Unnecessary hospital readmissions. Avoidable complications. All of these issues cause confusion and stress for patients and can lead to health problems, especially for the chronically ill. Failures of care coordination contribute between $25 and $45 billion in wasted health care services.[Source]
Why has this happened?
In many ways, the health care system has become focused on quantity over quality. In the current structure, physicians and hospitals are compensated based on the volume of services they provide. The goal has become seeing more patients and doing more procedures. Yet, this approach has not led to better overall health.
We have many talented and caring health care professionals in this area. But the system does not put them in a position to use those talents to the best advantage for all concerned.
Moving forward, we need to focus on outcomes over output. On prevention over treatment. And on making physicians the central source for information and guidance on matters of health. By changing this environment, we can give doctors more time and more incentive to coordinate care properly and focus on patients’ overall well-being.
Why is accessing care becoming a problem?
According to a Gallup poll,[Source] health care access is the nation’s most urgent health problem. What does this mean? Access refers to the ability for you to find the right health care providers and then to be able to get appointments and support from them when needed.
Unfortunately, we have begun to see a shortage of practitioners in the field. There simply are fewer doctors available to treat the population. And these doctors are often running very hectic practices, leaving little time for patient communication.
As a result, more and more people are having trouble either finding the right doctor for them – or getting in to see their doctors in a timely way. This can lead to important diagnoses and treatments being missed, adding another obstacle to maintaining your personal health.
How does this impact costs?
It’s estimated that the American medical system wastes approximately $750 billion a year while failing to deliver the best possible care – and half of these expenditures don’t contribute to improved health.[Source] This number is roughly equivalent to the annual cost of health coverage for 150 million workers or the budget of the U.S. Defense Department.
The Institute of Medicine's analysis of 2009 data shows:
- $210 billion spent on unnecessary services, like repeat tests
- $130 billion spent on inefficiently delivered services
- $75 billion a year on fraud
- $55 billion on missed prevention opportunities
- $190 billion on paperwork and unnecessary administrative costs
What could doctors be doing differently?
Studies show that 50% of physicians [Source] believe their job begins and ends with assessing health, prescribing and explaining treatment plans, and monitoring patient progress during regular office visits, rather than playing an ongoing “quarterback” role in your care, which is what you need to better manage your health.
Here are some other related issues:
- Only 23% of physicians surveyed cited access to health care as the most urgent health problem.[Source]
- Only 25% believe it’s their job to keep patients on track with their treatment programs between office visits by sending them ongoing reminders and alerts.[Source]
- Over 50% say they don’t communicate with patients between visits to provide care.[Source]
What is Independent Health doing to help?
We strongly believe that there are ways to overcome all of these challenges, when our whole community works together. The good news is, many innovative initiatives are already underway and are beginning to make a difference.
Our primary focus is to improve the coordination among your doctors – so they can care for you more efficiently and better communicate with you. Independent Health has fostered a unique partnership with area physicians, which puts us in the position to make those positive changes possible. Soon, you’ll be hearing more specifics about our efforts to make the system easier for you to navigate. Our role is to help keep you Well. Informed.
Our role is to help make the health care system simpler for you to navigate – by improving coordination among your doctors, while also making it easier for your doctors to communicate with you. We’re doing that by finding ways to foster collaboration among care providers and by designing new plans to meet the realities of today’s health care environment.
The best path to making the health care system both more efficient and more effective is to make your primary care doctor the quarterback for all of your care. When your doctor serves as the one central source for information and guidance on all matters of your health, they are able to coordinate your care properly and focus on your overall well-being.
Our unique relationship with Western New York doctors enables us to facilitate these important changes – so we can simplify how the system works to improve your health.
How are we helping doctors play a central role in your care?
Independent Health has implemented The Primary Connection – a select collaboration of Western New York primary care physician practices dedicated to providing:
- More effective coordination of your care
- Improved communication between you and your doctors
- High quality care focused on improving long-term health
Here's what's unique about the practices participating in The Primary Connection:
- Focused on providing the right care, at the right time, in the right setting.
- Work with specialists and community-based health services to improve the way care is coordinated – eliminating unnecessary visits and their associated costs.
- Available to see you more often on short notice, reducing the need to use urgent care or emergency rooms.
- An Independent Health Practice Care Coordinator (PCC) is on-site at the practice – a registered nurse who helps ensure quality, efficient and coordinated care.
- Stay up-to-date on your condition and treatment when you are hospitalized and follow up upon your release.
What are the advantages of our new Prime Access health plan?
Utilizing physicians affiliated with The Primary Connection, we are able to offer this unique tailored network plan – which gives you access to physicians who are highly focused on continuous improvement and are committed to following best practices. This plan also makes it much easier for you to navigate the health care system.
Prime Access differs in its approach from other health plans by offering standard and enhanced benefit levels that reward you with options to lower your out-of-pocket costs.
Prime Access gives you:
- Improved communication with your doctors
- Extended hours
- An on-site Independent Health Care Coordinator (at practices associated with The Primary Connection) to help doctors quickly and effectively coordinate care
- Better quality care for better long-term health
- Simplification and peace of mind
What are the advantages of our new Choice Plus health plan?
Developed in collaboration with the Catholic Health System and Catholic Medical Partners, Choice Plus features a network of physicians dedicated to providing greater coordination of care and better quality for better health outcomes.
Choice Plus is built on the foundation of strong partnerships with hospitals, facilities and providers who share a common vision for higher quality care and affordability.
Choice Plus gives you:
- A tailored network of providers
- Options for lowering your out-of-pocket costs
- More focused, patient-centered care
- An easier way to navigate the system
Why are tailored networks becoming a trend?
The shift toward network plans is driven by the need for greater affordability. In the past, similar plans have focused almost exclusively on reducing costs. But now, the accompanying focus on quality is designed to create a care delivery model that provides the highest value, while also improving care coordination and management.
Tailored networks are designed for members who are willing to engage in improving and managing their health risks – and are prepared to make the trade-off of open access for more affordable premium prices.
The percentage of employers offering a tiered network option increased in the Northeast from 15% in 2007 to 19% in 2011.[Source] As this trend continues, Independent Health is at the forefront, finding ways to make the concept work for Western New York.
How do doctors rate our efforts to make care more efficient?
We work closely with Western New York physicians and rely on their constant input, collaboration and feedback. Here are some of the results of this relationship:
- More than four in five practices view Independent Health as the health plan of choice and would recommend Independent Health to a patient.[Source]
- More than three quarters of local physician practices rate Independent Health as the plan that has established a true partnership with physicians, as well as helps coordinate health care across multiple doctors and hospitals.[Source]
What results do we have to show that our efforts are working?
Here are a few statistics that show our success in guiding members to use the health care system in the most efficient way:
- 90% of members visit their primary care physician first before going to an urgent care center.[Source]
- 95% of members have visited their primary care physician rather than going directly to the emergency room for non-urgent care.[Source]
- 62.5% of members have tried to contact their primary care physician prior to going to the emergency room.[Source]
- 94% of members feel their personal doctor explains things in ways that are easy to understand.[Source]
- 91% of members feel their doctor spends enough time with them.[Source]
What are some of the reasons for this?
There are two major factors. The first has to do with medically related issues: Not following doctor's orders, low involvement in personal health and neglecting to have routine health screenings. The other is lifestyle habits: Smoking, lack of physical activity, poor nutrition and excessive alcohol consumption.
Here are some surprising statistics on what's happening.
While these are national figures, they are representative of what we face here in Western New York.
- Only 51% of adults receive recommended screening and preventive care (national target is 80%).[Source]
- 83% don't follow treatment plans they've been given by their doctor exactly as prescribed.[Source]
- 21% of patients don't really have the skills and confidence to actively engage in their own health care. These people have incurred costs up to 21% higher than patients with the highest activation levels.[Source]
- 75% of patients don't follow doctor's orders for taking prescription drugs.[Source]
- 33% never fill prescriptions.[Source]
How do lifestyle habits affect the cost of health care?
We've all heard the phrase, "you are what you eat." But aside from poor nutrition, there are other lifestyle choices that cause most of our illnesses. Lack of physical activity, tobacco use and excessive alcohol consumption are other factors that lead to poor health and high health care costs. And 50-70% of all diseases are associated with modifiable health risks and are therefore preventable. That's good news because it means we can actually change things.[Source]
How does your lifestyle affect your health?
Consider these facts about the power you have to impact your own wellness:
- More than 43 million American adults (approximately 1 in 5) smoke.[Source]
- 1 in 3 adults – and 1 in 5 children between 6 and 19 – are obese.[Source]
- More than 25 million Americans have type 2 diabetes, 68 million have hypertension and 27 million have chronic heart disease.[Source]
- 33 percent of adults meet the daily recommendation for fruit consumption; only 27 percent get the recommended servings of vegetables per day.[Source]
- Only about 48% of Americans say they get 2 1/2 hours a week of physical activity.[Source]
- By 2030, medical costs associated with treating obesity-related diseases are estimated to increase from $48 to $66 billion per year in the U.S.[Source]
What can you do to improve your health?
There are numerous ways to live healthier and help lower costs. It takes work, but making good decisions is easier than you may think. Here are some basic guidelines:
- Eat better. It can be more expensive to eat healthy foods. But, in the long run, avoiding all the fat and sodium of cheaper fast foods is well worth it.
- Exercise. Just walking thirty minutes a day can help reduce your chance of heart disease. It also prevents obesity and increases overall mental and physical, wellness.
- Stop smoking. Literally twenty minutes after you stop smoking, your blood pressure lowers. A few hours later, your oxygen levels return to normal. It's not easy to quit, but the health benefits are incredible.
- Use generic prescriptions. By law, generic versions of drugs must work as quickly and effectively, and must be equally safe as brand name drugs – and they usually cost just a few dollars.
- Track your health care expenses. Look over the information you receive from your insurance provider and make sure you understand what you're being charged for, and why.
How can Independent Health help?
The RedShirts are here to help you do your part to manage your health by providing the tools and information you need. We make it easier to understand what changes you have to make, and how to get there. So you can make decisions that fit the lifestyle you want to lead. We're here to help you stay Well. Informed.
From new nutrition benefits to $0 preventive services to online wellness programs, Independent Health is working every day to create new ways for our community to get healthier – at work, at home and at play. Benefits vary by plan.
How do we help our members afford to eat better?
Our new nutrition benefit is one of the ways Independent Health supports our members in making the right lifestyle choices. For every $2 you spend on fresh fruits and vegetables at TOPS Friendly Markets, you will receive a $1 credit back, to be spent in-store on future grocery purchases. You can earn up to $1,000 on your family's food purchases each year.
*Money back is in the form of store credit for future purchases. Available on select Independent Health plans. Excludes Medicare Advantage plans. Benefits vary by plan.
How can our plan benefits help you save money and improve your health?
You'll find our plans combine great benefits with affordability: low copays, low premiums, gym memberships, vision discounts and more. We also offer $0 preventive services, including mammograms, cholesterol screenings, colonoscopies and many more. The earlier you detect a health issue the better, so take advantage of these services. They save you money – and could save a life.
Benefits vary by plan.
How do we help you get in better shape?
FitWorks℠ is our online wellness program, which features a Well-Being Assessment, as well as goal setting and tracking tools. You can share recipes, workout ideas and accomplishments with fellow users, and link to additional wellness programs and services.
Benefits vary by plan.
What health-related services do we offer our members?
- Wellness Discounts – We've partnered with a variety of organizations to offer you a range of valuable wellness discounts on everything from massage therapy to dental discounts.
- Health Tools – Our online health tools provide you with information on hundreds of health topics, so making informed decisions about your health is quick and easy.
- Treatment Cost Advisor– This online tool helps you estimate your costs for hundreds of health care services, so you can be prepared financially.
- Live Nurse Chat – Our registered nurses can answer your questions about a variety of health topics and guide you to online resources.
- 24-Hour Medical Help Line – If you can't reach a doctor right away, take advantage of our 24-hour help line (1-800-501-3439) where registered nurses are on call.
How do we help employers who want to offer programs to their employees?
We provide employers with health and wellness initiatives to help improve their employees' health, reduce medical costs and improve productivity. Our workplace wellness programs, tools and resources are available for any size company and include our online engagement tool, FitWorks,℠ and much more.
How are we helping the Western New York community?
To help Western New Yorkers lead happier, more health-conscious lives, we've partnered with area businesses and institutions to develop the following programs:
- Fitness in the Parks – We teamed up with YMCA Buffalo Niagara and local parks to promote the value of a healthy lifestyle and encourage Western New Yorkers to get active.
- Independent Health Family Branch YMCA – Join in health and wellness activities at the YMCA's newest branch. Independent Health representatives are on-site offering health and wellness activities, including customized fitness programs for our members.
- Biggest Loser Niagara Resort – A community initiative aimed at prevention and wellness. Inspired by NBC's hit weight loss series The Biggest Loser.
- Explore You/Explore Together – In partnership with the Buffalo Museum of Science, "Explore You" is an interactive health science studio that allows visitors to learn about choices they can make to improve and maintain their health. "Explore Together" is a series of events where children participate in health-related physical, educational and hands-on activities.
How does the Independent Health Foundation help our community stay healthy?
Established in 1992, the Independent Health Foundation works to improve the health and well-being of all Western New York residents.
- Healthy Options – Developed to educate our community on good nutrition and help people make healthier choices when dining out. At healthyoptionsbuffalo.com, you can find participating restaurants, view menus and access an online calorie counter.
- Fitness for Kids Challenge – This free, community-wide program was created to help combat the rising rates of obesity and type 2 diabetes in Western New York children.
- Soccer for Success – This youth development program, funded by the U.S. Soccer Foundation, helps provide children in at-risk Buffalo communities with a way to combat childhood obesity.
How much money could be saved if our community gets healthy?
When you lower disease rates, you lower health care costs. It's as simple as that. Here's one example: If New York State residents lowered their body mass index (BMI) by just 5%, the state could save 7.2% in health care costs. How much does that add up to?
More than $40 billion in savings by 2030.
The number of New York residents who could be spared from developing new cases of major obesity-related diseases includes:
When you choose Independent Health, you get everything you need – and deserve – from your health plan. Here are some of the advantages to being a member.