During his keynote session at the recent TAHP Texas Covered Health Care Conference, Dr. Marty Makary characterized the current healthcare service delivery culture as one that burdens the system with the overutilization of inappropriate services.

He outlined a path that bends the quality and cost curves: first, foster trust and transparency across stakeholders; and, second, address member’s underlying issues by enhancing access to data and appropriate care.

It’s not unreasonable to imagine that this “movement” hinges on elevating care coordination triggers and workflow processes. Yassin Sallam (left), Dina’s regional vice president attended the show in Austin. Here are his four takeaways to help fast track the movement.

1. Re-building Patient Trust

In Texas, 1-in-3 ER claims are out-of-network, compared to the national average of 1-in-5, resulting in severe out-of-pocket burden. This is in part attributed to the quality of provider directories. 

The new No Surprise Act provider directory verification mandate is intended to enhance directory accuracy for Medicare Advantage and Medicaid. Moving forward, care coordination platforms will need to interface within a network of providers to minimize leakage and avoidable out-of-network claims and Dina is working towards methods that support robust indexed networked providers. 

2. Sensitivity Drivers for Proactive Care Management

Dr. Mark Stephan, chief medical officer at Equality Health, frames the Health Care Payment Learning and Action Network (HCP LAN) through an operational lens. Most notably, at-risk service providers are managing through thinning primary care capacity. Cross-organizational case management is merging access to clinical and behavioral health services, and compiling actionable data to trigger proactive work streams prior to adverse events. 

The community has an opportunity to share responsibility across provider types. For example, dentists can educate patients on nutrition and diabetes; cardiologists can give flu shots.

EMR technology investments are costly. The “glue” that ties stakeholders associated with different plans across the care continuum must plug-and-play in a cost-sensitive fashion. Dina is positioned to seamlessly integrate with existing case management functions to extend a more intimate level of care management to target patient segments.  

3. Texting to Nudge More Engagement

Texas Health and Human Services (HHSC) will develop and implement initiatives to create program efficiencies and modernize electronic communication via texting. In addition, care coordination platforms stand to add value by leveraging texting to identify and classify specific patient/member segments on a particular care continuum, and triggering coordination workflow streams that deliver appropriate services at the right time.  

4. Emerging High-Value Transition Pathway

Medicaid is adopting payment design strategies from Medicare Advantage, and the Emergency Triage, Treat and Transport (ET3) payment model is a great example. The impact of a fully adopted ET3 model opens up specific alternative care pathways impacting return-to-acute costs. Structuring care pathways that proactively anticipate, and divert, care delivery from the in-patient hospital setting and into the home center is now in play for at-risk stakeholders. 

The SNF 3-Day Rule Waiver, which resolves the requirement for a three-day inpatient hospital stay prior to a Medicare-covered extended-care service, activates a high-value transition pathway. At-risk stakeholders must elevate member engagement, oversight and monitoring so that alternative interventions are timely activated. Forward-looking at-risk stakeholders, medical transportation organizations, and skilled nursing facilities (SNFs) are paying attention, and we are excited to play our part in the activation sequence.

Read Yassin’s complete conference recap on LinkedIn.

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