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How personalized health journeys drive better outcomes

Breakout: The Importance of Personalized Health Journeys for Longitudinal Care

Speaker: Mike Shepherd, MD, Senior Medical Director, Behavioral Health Strategy and Operations, Geisinger Health Plan

Speaker: Tracy Alvarez, Vice President, Medical Care Solutions, Blue Shield of California

Speaker: Dale Brickley, PhD, MBA, LPC, CSOTS, Senior Director, Operations, Wellspan Philhaven

Speaker: Adrian Sovik, BSN, RN, Director of Healthcare Management, Amerigroup

Moderator: Eric Glazer, VP, Solution Strategy, Teladoc Health

Managing chronic conditions can be challenging. People with one or more chronic conditions often need to make and sustain significant behavior changes in their self-care, diet and more to achieve their goal of living a healthier life.

With the right strategy, organizations can support individuals facing these challenges. At Forum 2023, Eric Glazer, Vice President of Solution Strategy at Teladoc Health, led a discussion with health plan leaders who talked about how their organizations have developed personalized health journeys for longitudinal care. Using data and technology, as well as more human-based approaches, these health plan leaders explained their approaches to achieving better long-term health outcomes for chronic conditions and mental health.

Personalizing journeys across a broad population can be challenging for organizations due to scale. According to Adrian Sovik, BSN, RN, Director of Healthcare Management at Amerigroup, virtual care and understanding the data can each play an important role in reaching these individuals.

During the pandemic, Amerigroup used heat maps to determine that the rising cases of sepsis within their population were driven by diabetes. They then partnered with Teladoc Health to launch a diabetes management solution in the areas where they saw the highest rates of emergency room visits and hospitalizations.

“It’s impossible to touch all the members that need our help. Partnering to launch these virtual solutions is the way of the future. We need the data to pick the right solutions.”

Adrian Sovik

Director of Healthcare Management, Amerigroup

When it comes to personalized health journeys, virtual care can also have a positive impact for members with complex conditions. This includes members facing mental health challenges or lacking convenient access to in-person care.

Tracy Alvarez, Vice President of Medical Care Solutions at Blue Shield of California, said virtual care has enabled her organization to get ahead of how they support their members with achieving better health outcomes. Because virtual care increased healthcare accessibility during the pandemic, members’ trust in virtual care grew, especially for virtual mental health, where its year-over-year use tripled.

Members who are far away from a brick-and-mortar facility or need the help of a caregiver, can access care virtually. For Alvarez, whose father lives in a different city, she can help him get the care he needs.

“My father’s providers are able to monitor his blood sugar, his defibrillator, and his pacemaker, all without us ever having to be in the doctor’s office, which is four hours away from me,” Alvarez said. “We can be together virtually during his telehealth appointment.”

Because of the connection to increased spending, improving the members’ mental health journey was of particular concern for Mike Shepherd, MD, Senior Medical Director, Behavioral Health Strategy and Operations at Geisinger Health Plan.

Using a more human-based approach, a team of “Care Connectors” helps members get the care they need. All with years of experience in behavioral health, Care Connectors understood the care members needed and helped connect them with the appropriate providers.

“Over time, our Care Connectors built relationships with our providers,” Shepherd said. “By interacting with hundreds of providers they’ve learned: ‘Who uses which types of treatment?’ or ‘Who will see patients with a specific set of problems?’”

Shepherd said they also maintain a database so Care Connectors can direct members to providers who have availability within specific timeframes.

Given the complexities of mental healthcare, Dale Brickley, PhD, MBA, LPC, CSOTS, Senior Director, Operations at Wellspan Philhaven, said his organization has created a “No Wrong Door” approach.

“We want to make sure our physical health partners are connected to our care navigators where those coordinated care efforts happen,” Brickely said. “They can get the right person to the right spot before the illness is an emergency.”

Brickley added, “Providing asynchronous content and multiple virtual care touch points, we have opportunities to overcome the shortage of providers while still being proactive to prevent the need for emergency care.”

“We need to reimagine care and here and provide people with touch points,” Brickley said. “Those touch points don’t have to be sitting in an office with the psychologists for an hour.”

Virtual care provides tools for rapid, brief interventions to keep individuals on track on their health journey, Brickley said.

According to Shepherd, virtual care and digital tools also provide resources to augment providers’ care.

“It’s an added security measure for the primary care doctor,” Shepherd said. “I’m not just simply giving medication to the patient. I’m giving them patient more—self-management modules, measurements to see progress.”

“We’re all trying to solve the same problem—more integrated, personalized, whole-person care,” Alvarez said. “This can be challenging with limited resources.”

The use of new technology and integrated platforms can enable care managers to support people in a more personalized way. At Blue Shield of California, the development of the “Care Connect” platform gives care managers a 360-degree view of the member and their mental and physical health, enabling deep insight into what’s going on in the member’s life.

“We have members who can’t go to their physical therapy appointment or to cardiac care because they don’t have transportation,” Alvarez said. “At their fingertips, those care managers are able to go in and assign transportation to that member to get them what they really need.”