Taking the First Steps with Health Direct Partners

The Problem

The last post described self-insured health plans in the United States that provide more convenient and more effective healthcare for their members at half the cost paid by other Americans. That is not the care that most people in this country experience. This matters to every employee and employer in the country. Health care costs are so high that they interfere with your employer’s ability to give you a raise. They have been forced to shift those health costs to you in the form of co-pays. These charges have gotten so high that they are straining the finances of many households around the country.

Better care at lower cost is important to you. I don’t just write about healthcare; I work with others to make it better. You can have better health at lower cost now.

The Health Direct Partners Solution

Better Care is Less Expensive Care

The best care provides much better clinical and financial outcomes by reducing hospital admissions, length of stay, and specialty referrals.

Focus on the Right Problems

Chronic diseases generate the most medical costs. The sickest 5% of individuals generate half of all your health care costs. The next 15% bring that number up to 86%. Focus on the high-risk individuals at first to prove you can improve health and save money. That is one of the main benefits Health Direct Partners brings to you.

Use a Proven Approach

The National Academy of Medicine of the National Academy of Sciences advises major medical stakeholders in the United States on healthcare policy. Twenty-two years ago, they recognized that we had not changed our approach to chronic diseases so that we manage them more effectively. They wrote a guidebook called Crossing the Quality Chasm. The name was no accident. They called out the failure explicitly. “The American health care delivery system is in need of fundamental change…Quality problems are everywhere, affecting many patients. Between the health care we have and the care we could have lies not just a gap, but a chasm.” Their specific recommendations for change follow and Health Direct Partners is following them to the letter.

“Given the magnitude of the change that is required, the committee believes that leadership at the national level is required to initiate the process of change by taking two important steps. First, a short list of priority conditions should be promulgated by the Department of Health and Human Services, and all health care stakeholders should then focus attention on making substantial progress toward the establishment of state-of-the-art processes for these conditions…”

Step One: Bring Together the Stakeholders

§  The leaders in Health Direct Partners have a long history of collaborating with other stakeholders to provide what employers and employees need. Now we are integrating those best-in-class stakeholders to provide a comprehensive solution and a carrier alternative to self-insured employers and other payers.

Step Two: Identify Fifteen Priority Conditions for Initial Focus

§  “Based on their prevalence, expense, or policy relevance: cancer, diabetes, emphysema, high cholesterol, HIV/ AIDS, hypertension, ischemic heart disease, stroke, arthritis, asthma, gall bladder disease, stomach ulcers, back problems, Alzheimer's disease and other dementias, and depression and anxiety disorders.”

§  The conditions in bold type are the ones we will begin with because they are the ones for which best practices are most firmly established. Obesity, chronic kidney disease, other arterial disease, and congestive heart failure are also part of our list. In the 22 years since Crossing the Quality Chasm was written, we have learned that aging and most chronic diseases are related and that optimal medical therapy for the conditions in bold type reduces all-cause mortality.

Step 3: Execution

Health care organizations, clinicians, purchasers, and other stakeholders should then work together to

(1) organize evidence-based care processes consistent with best practices, (

2) organize major prevention programs to target key health risk behaviors associated with the      onset or progression of these conditions,

(3) develop the information infrastructure needed to support the provision of care and the ongoing measurement of care processes and patient outcomes, and

(4) align the incentives inherent in payment and accountability processes with the goal of quality improvement.

The Health Direct Partners Comprehensive Solution

The Carrier Alternative (best in class carrier services)

§  Third party claims administration

§  Direct contracting

§  Preadmission hospital negotiations

§  High-touch concierge services

§  Stop loss premium service

§  Medical management

§  Patient engagement

§  ACO network

§  Specialty pharmacy

§  Prior authorization

§  Claims audit and negotiation

§  Utilization review

§  Real time clinical and financial analytics with employer dashboard

§  Case management

§  Transitional management

§  Chronic care management

§  Improved care for patients with high-risk, high-cost conditions

§  Medical crisis assistance

§  Care navigation

§  Care coordination

§  Nurse coaching for chronic conditions

§  Chronic Care Management Services

No one entity can improve health and reduce costs at scale. We are bringing stakeholders together to begin that journey. These resources in combination result in better clinical and financial outcomes.

IT Platform

§  Pulls high-risk cardiometabolic patient list from TPA claims data

§  Identifies gaps in care and provides list to nurse coaches/case managers

§  Provides an engagement platform to integrate nurse coach activities

§  Reviews OMT achievement by organization, clinic, and provider at baseline

§  Reviews same information quarterly

§  Provides baseline and quarterly clinical and financial analytics

Other Support

§  Protocols for hypertension, type 2 diabetes, coronary artery disease, other artery disease, chronic kidney disease, and congestive heart failure

§  Baseline and continuing education for providers and nursing staff with certification.

•        Detailed patient education for hypertension, diabetes, coronary artery disease, chronic kidney disease, congestive heart failure

•        Substack updates at Slow Aging, Delay Chronic Disease Development

Pilot Program

§  Perform baseline clinical and financial analytics.

§  Identify clinical champion, IT, and administrative contacts.

§  Identify early adopter PCP and nurse practitioner.

§  Train PCP and nurse practitioner in clinical and IT systems.

§  Identify high-risk, high-cost patients from practice management system.

§  Begin enrolling patients.

§  Add nurse practitioner as patient volume warrants.

§  Perform quarterly clinical and financial analytics.

§  Discuss opportunities for improvement.

§  Develop a strategy to spread the model to other institutions.

§  Publish.

We understand every practice has a different culture and priorities. We are very flexible in adjusting our solutions to your needs and preferences.  We begin with best practices as we understand them, knowing they will change as we move forward.

We have already begun the journey with several employers. Let’s get started!