BLOG — Investing in the Right Care at the Right Time

Billions of dollars every year are wasted on treating preventable illnesses and disease – money that could be used to provide better health care and improved outcomes. When consumers regularly engage with care teams focused on prevention, however, they tend to receive higher-quality care in far more coordinated ways and remain healthier over time. 

 So why is it that consumers mostly interact with the American health care system once they’re sick rather than before they’re sick?

The Alliance of Community Health Plans (ACHP) member companies are focused on delivering the right care at the right time. Whether screening consumers for early detection, keeping American families immunized or emphasizing disease prevention – these nonprofit, community-based health plans want to keep consumers healthy. This investment in health and wellbeing leads to healthier communities, better outcomes and improves value in the health care system.

According to recent Centers for Medicare and Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA) quality ratings, ACHP members outperform other health plans on preventative measures, including childhood immunizations, managing chronic conditions, testing and screenings. In fact, 23 of ACHP’s 24 members in Medicare Advantage were rated four stars or above by CMS, with one-third of all health plan contracts awarded 5 stars offered by ACHP members.

ACHP member companies are modernizing the industry from the current sick care model to one designed for wellbeing:

  • Kaiser Permanente encourages regular checks to control high blood pressure through its Hypertension Program Improvement Process. As a result of this $0 co-pay program, the hypertension control rate for Medicare members is 91 percent and 83 percent for commercial plan members, compared with the national average of 54 percent.
  • Dean Health Plan partners with Wisconsin Medicaid to pilot coverage for doula services based on strong evidence of effectiveness in improving birth outcomes for populations with the most significant disparities. The health plan also uses social needs screening data for all maternal health programs to connect women to community partners and resources to improve maternal health outcomes.
  • Point32Health negotiates outcomes-based contracts with pharmaceutical companies that tie payment to real-life results for Point32Health patients. If the therapies don’t work, drug makers don’t get paid.
  • Scott and White Health Plan collaborates with Cricket Health to prevent and manage chronic kidney disease. Cricket identifies at-risk members for Scott and White Health Plan to provide early diagnosis and treatment.
  • Fallon Health’s Summit ElderCare PACE Centers provide seniors with a centralized location to receive medical care, social services and care coordination, allowing seniors to maintain their health and independence while living safely in their communities. 98 percent of participants and caregivers report that the PACE centers have made a positive difference in their quality of life.
  • Aspire Health educates and engages the Monterrey, California community on diabetes prevention, including by offering an online risk assessment and educational resources. The health plan also identifies and enrolls at-risk youth and adults with pre-diabetes in educational and prevention programs, and partners with over 100 providers and two hospitals referring patients diagnosed with pre-diabetes or diabetes to Aspire Health.
  • HealthPartners developed new processes for identifying, treating and managing diabetes, leading to better care outcomes. HealthPartners’ rate for Optimal Diabetes Care as measured by Minnesota Community Measurement’s bundled diabetes measure was 49.4 percent compared to a statewide average of 45.4 percent.
  • Independent Health utilizes the Brook+ remote care platform to prevent and manage diabetes through monitoring, live coaching and on-demand education at no cost to members, leading to 24 percent of beneficiaries enrolled over 10 weeks in 2021 to achieve 5 percent weight loss.

ACHP member companies partner with providers, patients and caregivers to improve both care delivery and health outcomes. As Dr. Bechara Choucair, vaccine coordinator for the White House COVID-19 Response Team, noted in Modern Healthcare, ACHP members are leading vaccination efforts in their community by partnering with community organizations, delivering vaccines to those unable to travel, serving as public vaccine ambassadors and reaching out through robocalls, emails and texts.

Learn about ACHP members’ efforts to advance health outcomes for everyone in their communities here.