Coordinated-Care Models Begin to Catch Attention of State Policy-Makers

Andrew Kitchenman | December 15, 2014 | Health Care
UnitedHealthcare draws on Camden experience, while statewide collaborative could affect Medicaid funding, transportation

Dr. Edith A. Calamia, chief medical officer for the UnitedHealthcare Community Plan.
A series of small programs that provide intensive, coordinated healthcare to some of New Jersey’s sickest residents is drawing the attention of statewide policymakers, as well as one of the state’s largest health insurers.

UnitedHealthcare is expanding on the work it’s been doing with one of these groups — the Camden Coalition of Healthcare Providers — into a model of care delivery that it’s rolling out across the state.

In this model, a nurse is assigned to coordinate the care that patients receive, meeting in person to monitor their health and ensure that they visit their doctors and take the right medicines. This is in contrast to traditional insurance models, in which the coordination is done over the telephone, which can result in missed calls and appointments.

Along with changes in health insurance, a new group of intensive-care coordination organizations known as the Good Care Collaborative is starting to affect state policy. Changes recommended by collaborative members are being considered in the statewide contract for providing transportation for Medicaid recipients. In addition, the state is considering carving out 10 percent of its Medicaid care-coordination funds for the kinds of in-person efforts championed by collaborative members.

Dr. Edith A. Calamia, chief medical officer for the UnitedHealthcare Community Plan, said the insurer is drawing on the work of the coalition led by Dr. Jeffrey Brenner in its statewide approach to patients who use healthcare the most.

“This is one of the toughest places to make this work, because of all of the amazing challenges that the people here in Camden face every day, in terms of poverty,” Calamia said at a recent event at the coalition’s headquarters.

Calamia said that nurses who have managed patients’ cases over the phone “were not able to make the impact that they wanted to make.”

But a more intensive approach is leading to reductions in the number of patients being readmitted to hospitals after an initial visit, including those who are making fewer trips to emergence departments.

“We’ve seen incredible reductions in the patients that we co-manage with the coalition,” said Calamia of the ongoing collaborative between the insurer and the Camden organization.

The state also is attempting to expand this model through the Medicaid accountable-care organizations — care-coordination groups being launched throughout the state, in which any savings from reduced healthcare use will be shared between insurers and local providers.

Lawnside resident Miguel Rodriguez points to his own experience with the Camden Coalition as an example of how having care coordinators work closely with him improved his health.

After a prison stay, Rodriguez visited Cooper University Hospital because of shortness of breath. While he met coalition care coordinators in the hospital, he skipped two subsequent appointments with them at his home as a result of his drug addiction. But he was impressed when they came to visit him a third time, which led to him going to a primary-care provider. This is turn helped him stop his drug use and getting heart bypass surgery. He’s since received treatment for multiple chronic conditions — including chronic obstructive pulmonary disorder — and become a drug and alcohol counselor.

“They are helping me with my recovery, my housing, my medication. I mean, I didn’t have nothing. I was broke,” Rodriguez said.

Calamia said the results in New Jersey are being shared throughout UnitedHealthcare nationally. She added that the company is considering ways of disseminating the data more broadly.

She said that meeting patients in their homes can help nurses recognize environmental-health challenges, such as the threat to children from lead paint, as well as to learn more about the obstacles that patients face accessing healthcare.

“They’re on the phone, and they want to help with those things, and they can connect with some local resources, but it’s not the same as me standing here and looking in your eyes and telling you that I really care about what happens to you,” Calamia said of the difference between phone-based and in-person care coordination.

Along with the regional care-coordination organizations like the Camden coalition, Trenton Health Team, and Greater Newark Healthcare Coalition, the collaborative has spotlighted the work of groups that specialize in specific groups of patients.

These include the Program for Assertive Community Treatment, which serves those with severe mental illnesses; the Nurse-Family Partnership, which provides home visits with expectant and new mothers; the Ryan White Program, which helps patients with HIV/AIDS; and Housing First, which links patients with healthcare and social services by starting with finding them permanent homes.

Brenner said gathering data in randomized control trials — including one in Camden — would be important to building the national case for similar programs. But each program in the state has been building up evidence that justifies its funding, he said.

“These are expensive models that require higher fees than a typical Medicaid patient needs,” Brenner said, adding that Medicaid has a history of meeting the needs of the average patient, but not those of sicker patients served by the intensive programs in the collaborative.

“As you become an outlier and you become sicker and sicker and sicker, the Medicaid system — the providers and the insurers — don’t do a good job of pivoting in real time to the moment-by-moment needs” of patients as do the collaborative programs, Brenner said.