Today’s IT has made many advancements possible in the health care industry. Employers should look for a carrier that utilizes these advances in the field of population care management (PCM).
“The main function of the PCM department is to do outreach to members in need of certain health care interventions,” says Dr. Mark A. Roth, a physician adviser for the population care department of Kaiser Permanente.
By using health IT to augment PCM, physicians can improve preventive care as well as how chronic diseases are treated.
Smart Business spoke with Roth about how technology has improved PCM, and how PCM can help employers reduce health care-related expenses like absenteeism.
How does PCM impact preventive care?
One way is reaching out and contacting people in need of preventive care screenings, like mammograms, Pap tests or testing for colon cancer. Through the use of state-of-the-art computer tracking and monitoring programs, the PCM team is able to identify members who are overdue for preventive screenings.
The criteria used to identify these members are based on national evidence-based guidelines that tell us certain age ranges of people who need to have these screenings done for cancer prevention or early detection of cancer. Our electronic programs allow us to quickly identify which people in a given age range have not had the tests done in the specified timeframe.
The PCM team is then able to provide outreach to patients who are overdue for tests. The outreach can occur in the form of a letter or a phone call. For example, a letter is mailed to the member’s home to alert her that she is overdue for a test and would offer a phone number for her to call for assistance with scheduling an appointment. In some cases the overdue member may receive a phone call. Sometimes the calls are made by live callers, and sometimes they are made via interactive voice response, in which a computer-generated call is made to the individual who needs one of these tests done.
How can PCM help control chronic diseases?
The main chronic conditions PCM deals with are diabetes and cardiovascular disease. The PCM department is comprised of four registered nurses, several licensed practical nurses, data analysts and support staff who focus on identifying and managing the care of members with high-risk indicators. One high-risk indicator they look for is chronic, very high blood sugar ratings. They can identify that through computerized registries. It’s basically the same computer platform used for preventive care screenings.
The nurse does a chart review to identify the issues that are contributing to poor control of the patient’s blood sugar. After that chart review, the nurse has a conference call with the patient’s primary care physician. The two of them devise a care plan for how best to address the uncontrolled nature of that person’s conditions.
As a rule, nurses are very good at explaining things to patients in more understandable language than physicians. Nurses use these phone calls to really try to get to know patients, work through their issues, and understand the lifestyle stresses that make it hard for them to fully comply with their care plan.
How does this proactive approach improve outcomes?
The new initiative went into effect in the last quarter of 2007. We focused on people with very high blood sugar levels. In medical terminology, that is defined as people who have a Hemoglobin A1c level greater than 9 that means their blood sugar level is very much out of the desired range.
We measure year to year what percent of the diabetic population has an A1c greater than 9. In 2007, 24 percent of our diabetic members had an A1c level higher than 9. In 2008 and 2009, that number was reduced to just about 15 percent more than a 30 percent improvement. Lower is better in this measurement; it shows more people have better control of their blood sugar.
Because diabetes is more than just blood sugar, we have to carefully control blood pressure and cholesterol as well. From 2006 to 2008, there were also significant improvements that occurred in the degree to which blood pressure and cholesterol were brought under control in our diabetic membership.
Why should employers care about PCM?
One more outcome to this activity, besides the improvements in blood sugar, blood pressure and cholesterol, is that we’ve also seen a reduction in the number of hospitalizations that have occurred from diabetic complications from 2007 to the present.
That is of interest for employers, because it keeps employees out of the hospital and functioning at a more healthy level, which results in greater productivity and less absenteeism.
If we can keep diabetics out of the hospital for complications, we can reduce health care costs. It’s a win-win for employers. It’s been well demonstrated in scientific medical research that if a health care system can improve blood sugar, blood pressure and cholesterol control, many of the cardiac complications of diabetes, which are the most feared, can be prevented. That is really what this program is about trying to prevent complications of diabetes.
How can PCM keep your employees healthy and productive at work?
One important PCM function is that it occurs outside of the setting of a traditional doctor’s office visit. For example, a patient may be so busy at work and with family life that they don’t have time to come in and see the doctor, even if they have a chronic condition like diabetes. The PCM function we’ve described identifies those members even though they haven’t come in for a doctor’s visit in some time, and allows us to proactively reach out to them to remind them that they are in need of certain treatments to stay healthy.
Dr. Mark A. Roth is a physician adviser for the population care department of Kaiser Permanente. Reach him at (440) 786-8296 or firstname.lastname@example.org.