How can navigation be eased?
There are some alternatives being discussed, such as group appointments, which could expand the time a patient is with a doctor and possibly improve the discussion of conditions and treatments.
Group appointments not only save time but also provide patients with peer-to-peer interaction that the patients can relate to. When you have a group of people who share the same condition, they can talk about their experiences in a way that only someone with firsthand experience can, and they can be very effective in transmitting some information about their conditions.
Can an integrated delivery system make a difference?
Integrated delivery systems are another possible way that navigation of the system can be eased. Integrated delivery systems — which are networks of health care providers and organizations designed to provide coordinated services to a defined population — allow multiple health services to be managed by the same organizing entity. This can improve coordination of care and be easier on the patient.
A health plan can be an important part of this because it has access to all of the claims data of its members and it has the capacity to share that information with providers. That way, a provider gets a clearer picture of a patient’s condition and history and can make more effective and efficient care decisions.
What are some consequences of poor navigation?
Poor navigation compromises both health care efficiency and clinical consequences. Health care consumers pay the price for poor coordination of services. There can also be inappropriate utilization of services.
For example, when an emergency room is used for non-emergencies, the ability of ER personnel to do the best they can is compromised. Any time care is provided that could have been delivered in a more appropriate setting, costs are increased and quality of care can sometimes be diminished.
How can businesses help the situation?
Businesses have the capacity to work with a health plan to set the agenda for their employees who purchase health insurance. Initiating healthy lifestyle changes, rather than just reacting to illnesses, can prevent healthy people from developing chronic illnesses, and can also improve quality of life for those who already have chronic illnesses. Promoting a healthy environment in the workplace requires time and commitment, but will benefit both the employee and the employer in the long run.
S. Ramalingam, MD, MBA, is the senior medical director of medical management for UPMC Health Plan. Reach him at (412) 454-5702.
