Health Care

Health plan partners on post-care program

March 5, 2014
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Health plan partners for post-care program
NaviHealth partners with health care organizations to deliver post-acute care programs. Photo via fb.com

A health plan is partnering with a post-acute care management company on a new program to serve patients after they leave the hospital.

Grand Rapids-based Priority Health and Brentwood, Tenn.-based naviHealth said last month that they're partnering on a program dedicated to improving efficiency, communication and quality of care for members in post-acute care after a hospital visit.

Need for post-acute care

The program started in mid January and allows Priority Health nurses to work with local naviHealth personnel to measure individual needs and compare those needs to a database to help choose the appropriate post-acute care services.

Dr. Jay LaBine, chief medical officer at Priority Health, said there is a real need to reform post-acute care, and roughly 40 percent of people will need some sort of service after a hospital visit.

“We feel like this initiative helps improve the quality and efficiency," LaBine said. "It is really important for patients to get a seamless, well-coordinated experience. And it tends to be an area of medicine that is not well connected.”

Starts at hospital

Priority Health and naviHealth work with the insured members and the discharge staff before patients leave the hospital.

The program makes it easier for patients to transition from the hospital setting to a rehabilitation facility, said Amy Miller, a spokesperson at Priority Health.

“With programs like this, we see better outcomes with patients,” Miller said.

Goal setting

During the program, the staff helps set clear goals with members and speaks to their families about expectations and possible outcomes.

NaviHealth also uses a tool that helps align members with the most efficient and appropriate type of post-acute care service, such as a skilled nursing facility or an in-home service.

“It’s really a patient-centered way of understanding what was going to happen to them after leaving the hospital,” Labine said. “The hospital people didn’t really have a connection to the post-acute care people. They didn’t exchange information.”

The program, using the database tool, will also assist skilled nursing facilities to measure their care and use it as a means of improving their performance.

“This is a really big change for health care,” LaBine said. “What we found since we started in mid January, is patients like the fact that they know better what is going to happen to them. It gives them a lot of comfort that we are working together.”

Cost

Priority Health members will not face additional charges with the new program.

Improving efficiency in the post-acute care services will help avoid certain copay charges, since patients often end up in rehabilitation services longer than they need to be, according to LaBine.

“Right now, when people choose a facility, there is no way of gauging whether they are a top-notch facility, so that is going to help patients better understand their choices,” LaBine said. 

Partnering

LaBine said the health plan partnered with naviHealth, an "evidence-based company," due to their more than 10 years of experience in optimizing post-acute care and the specialized evaluation tool it provides.

Priority Health also chose naviHealth due to the local personnel who work with nurses.

“We felt that close collaboration, the relationship, was really important,” LaBine said. “Every community is a little different.”

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