By JULIE MINDA
On a day-to-day basis, population health company MissionPoint Health Partners processes and analyzes reams of patient data to determine how to help people access the health care system more effectively.
It was during one such data study that analysts realized that dozens of children insured by one MissionPoint client were filling their asthma prescriptions but were still showing up in emergency departments on a regular basis for relief from asthma complications. Further investigation revealed that the children's parents or guardians were buying the medication but not the more expensive plastic spacer that can deliver the medicine more effectively; and so the children had problems appropriately using their inhalers.
MissionPoint Health Partners member Flamauion Brown, left, has her blood pressure taken in her home by Grace, a health partner who helps her manage her health and access health care services. (MissionPoint does not share the last names of its employees with the media.)
MissionPoint representatives shared the information with their client — a self-insured employer — and the employer agreed to reduce the amount its employees had to pay for the spacer. Parents could get the reusable spacer at the reduced cost when they next filled the prescription. The emergency department visits for this group dropped to "almost zero," said Jason Dinger, chief executive of Nashville, Tenn.-based MissionPoint.
The spacer solution is one of many population health management tactics MissionPoint has employed to improve people's health and their experiences with the health care system while reducing the cost of their health care. MissionPoint also establishes integrated networks of providers and supplies nurses and social workers to help patients access those providers. MissionPoint's clients include self-insured employers, commercial insurers — including those on health exchanges — and Medicare and Medicaid plans.
Dinger said, "We are excited about what we've been able to do, including for the poor and vulnerable. Whether we're finding solutions for (patients) in food deserts or buying spacers for those who can't afford them, we're providing an actual response to the real needs of real people."
The right incentives
Founded in August 2011 and formally launched in January 2012 by Ascension Health's Saint Thomas Health of Nashville, MissionPoint currently has 190 employees in six states — Alabama, California, Florida, Indiana, Tennessee and Texas — most of them frontline navigators who interact directly with patients.
MissionPoint's model has its client organizations paying what Dinger says is a small, per-member, per-month fee for all of the insured "lives" that MissionPoint manages for that client. MissionPoint then receives an additional bonus payment when it meets quality and cost saving targets.
Dinger and Nicole Provonchee, MissionPoint vice president of business development, said MissionPoint meets its quality and savings targets in part by:
- Building a clinically integrated network of high-quality, low-cost health care providers in the regions where its clients operate. Networks can include Ascension employed clinicians and other providers.
- Creating financial incentives for network health care providers to follow defined best practices and to adopt consumer-friendly practices such as offering evening and weekend hours.
MissionPoint shares the bonus it receives from its clients for achieving its quality and cost targets with treating clinicians. In the case of Medicare clients, MissionPoint reaps those rewards through federal shared savings programs. In the case of its other clients, MissionPoint and the clients establish the targets and rewards through contracts.
"All the incentives are aligned towards better coordinated care," Provonchee said.
Care close by
MissionPoint can help employers set up on-site primary care clinics; it can offer work site-based telemedicine access to specialists; and it can provide wellness services including inoculations and screenings to clients' employees.
MissionPoint's analysis of the health care usage of its covered populations tells it what steps, or care paths, individual patients should follow to address health goals or issues, particularly in the case of high-risk patients or patients who are heavy users of the health care system. MissionPoint health partners, the nurses and social workers dispersed in all its service markets, contact patients directly to coach and guide them to appropriate care and care outcomes. The health partners normally have access to patients' electronic health records and can update the patients' primary care and other doctors through that record, as well as through secure electronic messages or calls. In some cases, the health partners are embedded in physician offices and can provide their updates to doctors in person.
Research has shown that people undergoing knee replacement surgery are more apt to avoid poor outcomes when they are compliant with medication directions, keep their follow-up appointments and make certain adjustments in the home. So, a health partner stays in regular contact with patients recuperating from joint replacement, usually in person or by phone, asking, "Did you get all your prescriptions filled?" "When are you scheduled to meet with your physician next?" "Do you have an elevated toilet seat?" "Have you removed your throw rugs?" The health partner will help the patient who is struggling with any of the steps.
Provonchee said, "They visit patients in the hospital to prepare them for discharge, they help set up and prep for appointments. They do home visits."
MissionPoint clients have seen reduced readmissions and reduced emergency department visits among their employees or members; and they've seen more of their employees and members select a primary care provider, Dinger said. One client saw a 12 percent reduction on its health plan spend.
Bob Henkel is president and chief executive of Ascension Health, which is MissionPoint's parent company. He said with MissionPoint's "experience and success in managing commercial, Medicare, Medicaid and marketplace populations, the organization is uniquely positioned to help Ascension's other health ministries in this work. MissionPoint has been very successful, well developed and it appears to be something that can be replicated across Ascension."
Henkel said MissionPoint is furthering Ascension's mission to care for underserved and vulnerable populations. That is because like many people in the U.S., many of MissionPoint's clients' employees or members are struggling to pay for their health care costs. In addition to health care, health partners help them access social services, spiritual care, food and financial aid.
Provonchee said, "One health partner learned that a member who had pneumonia, had a moldy mattress, and had it hauled away and found a way to have a new mattress donated and delivered to the member.
"We're making sure people don't fall through the cracks," said Provonchee.
Health partner helps Tennessee woman access medical, mental health help
In August 2014, "everything went haywire" for Shonda Finney, 41, of Rockvale, Tenn. First she was hospitalized with acute pancreatitis. After discharge, she experienced a worsening of chronic back pain and depression — she had been struggling with both conditions, but had avoided treatment because of cost concerns.
"I was overwhelmed," she said. She was concerned about the medical bills, about following post-discharge instructions, about managing her physical and mental health concerns.
She recalled at the time that through her insurance, BlueCross BlueShield of Tennessee's Network E, she had access to health partners who could help her handle these issues. Network E is a health insurance marketplace offering. BlueCross BlueShield is a client of Nashville, Tenn.-based MissionPoint Health Partners. As part of the contract MissionPoint provides health partners to help Network E members navigate the health system.
Through the service, she connected with multiple MissionPoint health partners — Cassandra Driver is her primary service provider. Driver talked with Finney about what she was facing and helped her figure out what to do. Driver assisted Finney with making doctors' appointments, prepping for the appointments and finding a therapist who was taking new clients and who was a good fit for Finney. Driver also follow-up by phone with Finney after her medical appointments ensure Finney was managing her health concerns. Driver once met with Finney in person before a medical appointment.
"I don't know where I'd be without them," Finney said of the health partners. "They helped me through a really hard time."
Finney said the health partners remain involved in her care as she continues clinical follow-up to improve her physical and mental health.
Driver, who has a caseload of about 45 to 60 people in the area, said that for people like Finney who are ready to act to address their health issues and other concerns, "we can provide the resources, and meet them where they are. It's not our agenda, but theirs."
Driver is a licensed counselor who worked as a director of social services for a long-term care facility before joining MissionPoint. She said that she is part of a team of health partners with various backgrounds — including social work, nursing and mental health care — that work together to help people address the barriers they face, including financial need and other issues related to social determinants of health.
Recently a member who has insurance through the health insurance exchange expressed concern about an overdue phone bill she couldn't pay. Driver helped the client with other financial issues to free up funds for the phone bill. "I don't have a magic wand, and so sometimes there's not a particularly resource that is exactly what they need. So sometimes we need to explain that we don't have that resource but we have others that can help.
"It's sitting with the member, and saying, 'No, this isn't fun, but I will stick by you … someone's here who wants to help," Driver said. "You can hear the relief when they hear there's a resource for them that they may never have even thought of."
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