When Dulcey Bean was diagnosed with a fast-moving form of breast cancer in 2016, the elementary school teacher dove feetfirst into treatment and all that it entailed. While still teaching fourth grade, she started the first of the weekly chemotherapy infusions that would last for more than four months.
Soon after chemo began, Bean realized that cancer treatment required more effort than she had anticipated. In addition to the energy-zapping infusions, she found that she had a number of questions about hospital bills, insurance coverage and treatment plans. Her husband helped make phone calls, but with a busy job himself, he too became overwhelmed.
Bean then remembered some information she had been given shortly after her treatment started. Her clinic, Northwest Medical Specialties (NWMS) in Puyallup, Wash., had just launched a three-year pilot program with her insurance company, Premera Blue Cross, to offer oncology patients a direct line to a patient care coordinator who would help schedule procedures, hash out billing issues and deal with confusing insurance statements.
Weary from treatment and with little time or energy to take care of the administrative tasks that went along with it, Bean gave Jessa Dunivan at NWMS a call. It was the start of a months-long relationship.
“If there was something I couldn’t handle, she was my go-to person,” said Bean, 49, who turned to the patient care coordinator for assistance countless times during treatment. “She really made my journey less stressful.”
A new way of caring
Bean is one of 700 cancer patients at NWMS’s six South Puget Sound clinics who have taken advantage of Premera’s new value-based care program. Currently only offered to clinic patients with Premera insurance, the program is expected to expand in the future.
The value-based contract turns the traditional care provider-insurer partnership on its head, with the end-goals of providing better care to patients and saving money. The approach does away with the conventional and often-criticized “fee-for-service” model, in which doctors submit bills to the insurance provider for procedures, tests and treatments.
Under the value-based model, Premera and NWMS agree on certain standards of care that must be met, and NWMS takes on a role that extends beyond just cancer care. The program gives the clinic incentives to minimize costs such as emergency room visits that can add thousands of dollars in expenses for the patient and the insurer during the course of care.
The patient care coordinators and their team are the most visible of the value-based program’s attributes. They are just a phone call or text away when a patient wakes in the middle of the night with a panic attack or nausea, for example. Dunivan and her counterparts can immediately enlist the help of an on-call NWMS doctor and deal with the concern in-house. The doctors’ familiarity with the patient also plays a role, and allows them to better deal with issues that crop up – unlike ER staff that may not know the patient’s detailed health history.
Help during hard times
Dunivan and five other patient care coordinators at NWMS’s Puyallup clinic help patients with the countless administrative and scheduling tasks they face during chemo treatment, allowing them to focus instead on treatment and getting better.
Dunivan recalls one newly diagnosed cancer patient who was so overwhelmed by the barrage of bills and statements arriving at her home that she didn’t open her mail for weeks. Dunivan connected her with an in-house social worker, who helped her sift through a grocery bag full of mail and deal with important documents.
“Without this program, patients have to be huge advocates for themselves,” says Dunivan. “Oncology has a language all its own. We’re here to take that burden off them and let them focus instead on getting well.”
Aside from the peace of mind the program brings patients, it has also already proven to be a cost-effective approach for Premera and NWMS. In the first year of the clinic’s three-year shift to the value-based care model, it has reported a 25 percent decrease in in-patient admissions, a 55 percent decrease in repeat hospital admissions, a 10 percent decrease in emergency department visits and a 21 percent improvement in hospital costs.
For the NWMS oncologists on the front line of Premera’s new patient care model, the adjustment has been significant. In many cases, doctors have taken on the role of both oncologist and primary care physician as they seek to meet all of a patient’s needs during cancer treatment. But patients in the program are responding remarkably well, says NWMS oncologist Sibel Blau, and that’s what counts.
“Having a patient care coordinator around watching everything, doing things for the patient and connecting us has made everything so much easier for the patient,” says Blau, Bean’s oncologist and one of the clinic physicians who has pioneered the program. “It allows me to spend more quality time with the patient instead of spending half an hour talking about their billing problems.”
A proven method
Value-based care is not an entirely new concept — the government-run Medicare program has had great success with the approach — but it is one that Premera hopes to perfect.
“We saw that the Medicare model worked for that population and we wanted to do it better,” says Dennis Hagemann, Premera’s director of strategic programs. The insurer’s agreement with NWMS includes an up-front monetary investment from Premera to implement new technology and train the staff, doctors and nurses in the new care model. Since the program is still new, it’s too soon to tell if the initial run is cost effective, says Hagemann.
“But this isn’t necessarily about money,” he says. “Premera is going through a brand and cultural change with the concept of being an advocate for our customers. It’s a model we believe in because it hits so many criteria for doing things differently.”
Two other Washington-based insurance plans have expressed an interest in what Premera is doing, Hagemann said, and NWMS has earned recognition for the value-based program from the National Committee for Quality Assurance, a nonprofit organization that accredits and certifies heath care organizations.
“The message we’ve put out there has resonated,” says Hagemann.
For Bean, who continues to call Dunivan with health- and billing-related questions even though she’s finished with active treatment, the program brought her peace of mind during a traumatic and scary time in her life.
“I never have to worry, Bean says. “(Jessa) worries for me.”