The burgeoning Medicare Advantage space provides ample opportunity for health plans to experiment with innovative techniques to better manage chronic conditions and coordinate care.
One of the companies leading this charge has been Minnetonka, Minnesota-based UnitedHealthcare which is using data-informed care navigators to support care for its sickest (and most expensive) Medicare Advantage patients.
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The country’s largest insurer is moving to expand the Navigate4Me program launched in 2017 to help Medicare Advantage beneficiaries suffering from complex and chronic diseases like congestive heart failure or acute health needs such as joint replacement surgery.
Early results showed that Navigate4Me was able to drive a 14 percent reduction in hospitalizations and 9 percent decrease in ED visits for congestive heart failure patients.
Currently, the program supports around 215,000 members, but the company is hoping to double that number in 2o19 by including post-hospitalization patients who need additional support, those recently diagnosed with Alzheimer’s Disease and members at higher risk for social isolation.
The company has nearly five million beneficiaries enrolled in its Medicare Advantage plans in total.
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Navigate4Me relies on trained care navigators who act as a point person for a patient’s healthcare needs by assisting in clinical or administrative tasks, following up on treatment plans and connecting people to social or community-based support like transportation or housing assistance.
This type of care management is enabled by a data infrastructure called the UnitedHealthcare Nerve Center which builds personalized profiles of patients in the program based on claims and clinical data, demographic information – and increasingly – sensor information from connected digital devices and wearables.
With eligible congestive heart failure patients, for example, UnitedHealthcare helps to provide a Bluetooth-enabled tablet, scale and blood pressure monitor to allow clinicians and care navigators track daily weight changes and intervene in the case of a worsening condition.
For diabetes patients in Navigate4Me, UnitedHealthcare helps provide connected continuous glucose monitors from vendors like Dexcom and fitness trackers to help deliver personalized coaching to mitigate symptoms.
The shift from episodic acute care to continuous monitoring and management of chronic conditions is being driven by new payment models like in Medicare Advantage, along with the rise of connected devices and sensors.
It’s a necessary shift as the healthcare system contends with an aging population made up of Baby Boomers more familiar with using technology and mobile tools.
“We’re building the next generation of care management by moving away from traditional models to a holistic approach that harnesses the power of real-time data and technology to deliver the right kind of individual support that can help people get well and stay well,” UnitedHealthcare Medicare & Retirement CEO Brain Thompson said in a statement.
“Combining new data-driven insights with the human touch of our care teams will deliver a more personalized health experience.”
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