GRAND RAPIDS, Mich. — Open Enrollment for Health Insurance currently underway, and as you probably know there can be big differences in insurance policies.
Here's something you should look for, one that practices value-based care, where doctors are financially rewarded for the quality of care they give. Not their quantity of patients.
This model of care was developed by The Centers for Medicare & Medicaid Services nearly 10 years ago.
Priority Health is one of the health insurers using this system.
"I was borderline high blood pressure, I was borderline diabetic. I had a very high BMI." Jen Hoeltzel was never able to get those health issues under control, until now, "Jamie was my cheerleader she was always telling me she was proud of me I could do it. Showing me graphs on my weight going down."
Jen is talking about her Care Manager. Her doctor assigned Jamie Heath to here to help get those health concerns under control, "She wasn't forgetting about me. She was constantly checking in on me texting me, emailing me, asking me how I was doing. Which was completely different than you go see your doctor then you go about your way."
That's Jamie's job as part of the Priority Health value-based care model, "I'm able to get to know them and able to make their plan of care more individualized." Care Managers like Jamie do everything from teaching patients how to read food labels to finding financial help to pay for medication.
"Our care managers are really the safety net that is really helping to make sure that patients with conditions don't fall through the cracks." Shaun Raleigh is a Population Health Professional with Trinity Health. She's part of the team transitioning Priority Health to value based care, "We finally recognized as a provider system that 80% of what makes up a person’s physical health is everything else that happens around them."
And believe it or not, Raleigh says COVID-19 is responsible for it, "The pandemic really highlighted the failures of a pay for service system."
Shaun isn't the only one guiding the change.
"We're doing this by not just doing a questionnaire but making sure that our providers are proactively looking through a list of patients who are undergoing chronic disease who have multiple risk factors to look at them as a person.", Michell Illich is a Vice President for Priority Health and says it might sound like something physicians should have been doing all along, but it's a shift in mindset, "So we're figuring out exactly what's going on to get that patient the care that they need to prevent illness verses treat illness on a fee for service activity base."
And Jen is seeing a difference, "I didn't feel like I was going to a regular doctor's appointment. I felt like I was going to someone who was going to help me reach my goals."
And she did.
"September 21st of this year. It was a year and I don't have any blood pressure issues, I don't have any sugar issues all my blood work is good and I'm down 55 pounds.". It's part Jen's hard work and part the work of her Care Manager Jamie who really got to know Jen, a mother of three, a breast cancer survivor, and a person who always put everyone else first. "We had a really long discussion about hypertension and dietary changes.", says Jamie.
Having a care manager has done more than improved Jen's health, it's given her confidence, “I can't believe that I'm actually here. That I actually completed something and did something and stuck with it for a year." She and Jamie have already set new goals for the coming year.
Many insurers who are part of the Affordable Care Act are using value-based care.
Healthcare workers have been reporting burdens and complications placed upon them by value-based care.
Now The Centers for Medicare and Medicaid Services is currently evaluating the value based care model with input from physicians to help achieve better care for patients.
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