Our plan has 4 major components that work together to maximize care and reduce costs for both the employer and employees.
- We Only Contract with Best-in-Class Hospitals. Our contracted hospitals, Alexian Brothers Medical Center at Elk Grove Village and St. Alexius Hospital at Hoffman Estates, ranked in the top 10 percent nationally in Overall Hospital Care and Overall Medical Care and top 25% nationally in Overall Surgical Care in 2017 by Care Chex.
- We Only Contract with Best-in-Class Specialists. Assessing the quality of a specialist is not as quantifiable as assessing a hospital at present. Our Specialists are hand-picked based on the recommendations of primary care physicians who have long practiced with them. We continually monitor the outcomes of specialty care and track patient satisfaction to ensure top-notch care. This information is used to guide our referrals.
- We Provide Accessible, Attentive Primary Care. Our Primary Care Providers are focused on the best health outcomes for our Members, whether that means frequent visits or longer visits. We aggregate patients in a few primary care practices so that the providers know how we work, we know how they work, and everyone knows our Members. Our staff and our processes back up our Primary Care Providers. All referrals requested by Members or their providers are made through our Care Coordinating Center to be sure our Members see the best doctor for them, that care is coordinated, and that everyone involved in care stays informed.
- Our Plan Does Not Have a Wellness Program; It Is a Wellness Program. Members self-report to us annually on a series of structured questions so we understand their health care needs. Our Primary Care Providers use this information combined with a panel of laboratory studies drawn annually to evaluate each Member at a yearly visit, focusing especially on preventive screenings (such as Pap smears, colonoscopy, and mammograms) and on hypertension, smoking and early stage diabetes. Nationally nearly half of Americans do not get recommended preventive services such as surveillance for colon cancer and counseling for smoking cessation. Our goal is 100 percent of Members receiving 100 percent of recommended preventive services.
The table below show the number of adults in 4 companies at the beginning of 2016 and the percentage of adult members in each who were smoking, had elevated cholesterol, hypertension or severe hypertension, who were prediabetic and diabetic upon enrollment. The columns to the right of each company show the percentage of members affected by each condition who were improved during the first year of enrollment. We were successful at managing hypertension because the condition can be treated with medications effectively and is less dependent upon life-style changes than mitigating smoking, high cholesterol, and pre-diabetes. We are working on educational programs to address Member behaviors to modify these risk factors more effectively. A number of members with diabetes had either never been diagnosed or were untreated because heretofore they could not afford medication.
|Company #1||Company #2||Company #3||Company #3|
|Avg age 49||% Improved||Avg Age 48||% Improved||Avg Age 38||% Improved||Avg age 45||% Improved|
|Cholesterol >240 mg/dl||16%||10% (1)||13%||11% (1)||16%||20% (1)||20%||14% (1)|
|Hypertension||35%||77% (17)||30%||38% (8)||16%||20% (1)||40%||71% (10)|
|Severe Hypertension||27%||76% (13)||20%||79% (11)||10%||100% (3)||20%||43% (3)|
|Pre-Diabetic (HgbA1c 5.7-6.4%)||37%||13%(3)||32%||31% (5)||32%||40% (4)||20%||43% (3)|
|Diabetic||3%||50% (1)||16%||55% (6)||6%||50% (1)||3%||0|
|Extremely Obese BMI>35||15%||1||24%||0||29%||0||14%||0|
*% Improved-Hypertension/Severe Hypertension-lowest subsequent BP <140/90mm Hg; Pre-diabetic-at least one value showing >0.2% decrease in HgbA1C, Cholesterol <200 mg/dl, Diabetes-at least one value showing >1% decrease in HgbA1c below baseline