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Program identifies at-risk patients early
Interventions are personalized to help patients
Traditional disease management programs that help patients manage their diseases after they become costly are like "arriving at the scene of an accident that has already happened," John Palumbo asserts.
That’s why I-trax, a population health management solutions company, has developed proprietary health technology to identify people who are at risk for chronic disease before the disease develops and before they start to have a lot of insurance claims, adds Palumbo, who is vice chairman and president of the Philadelphia-based company.
"Everybody complains about increases in the cost of health care, but if we don’t do something different, the funds are going to run dry. That’s why we decided to reinvent disease management and to take a proactive approach to patient care," he says.
Traditional disease management programs concentrate on as few as 1.5% of members for each disease or 8% to 11% of the population base when all the major chronic diseases are covered, Palumbo says.
In a traditional disease management plan, the targeted patients are those whose health care costs already are high or who have been hospitalized or had an emergency department visit.
The I-trax Health-e-Lifesm program targets people who are likely to become traditional disease management candidates in the next few years as well as those who are actively diagnosed.
"It is critical for us to get people to enroll in the program, even if they are not spending a lot of money on health care," Palumbo says.
Instead of stratifying patients by using only a health risk assessment that identifies patients who are sick or likely to get sick, I-trax uses a proprietary health evaluation that identifies patients most likely to get a chronic disease.
The system takes the person’s health information, patterns in care, and laboratory reports and is able to identify those who are likely to have a chronic disease.
Many of these patients never would have been in disease management because they have not had a claim.
"This means a patient who would never be in a high-intensity program because his or her claims were under $300 a year can be put into a program before the cost of care increases, instead of sitting under the radar," Palumbo says.
I-trax is the only health management company with integrated pharmacy management, he notes.
"We are shifting from acute to appropriate therapeutic medication therapy and medication compliance. It is more cost effective, and we often are able to dramatically reduce medication," Palumbo says.
The program can result in a 7% to 14% reduction in medical claims, he reports.
"We have the only patented scientific model which is powered by our scientific research partner, BioSignia, with actuarially validated claims and a patented clinical model that identifies patients prior to the onset of the disease," Palumbo says.
When I-trax begins to work with a patient population, many of whom are members of an employer’s self-insured health plan, the company compiles several years of claims, laboratory information, and pharmaceutical history and enters it into a sophisticated repository. Members who are actively diagnosed or at risk are contacted by a nurse case manager, who conducts the health evaluation as part of the enrollment process.
Based on the information gathered by the nurse case manager, the system creates a proactive care plan.
"We treat people, not diseases. We design a personal care plan for every member in an insured population rather than deliver a structured disease intervention based on a primary diagnosis," Palumbo says.
For instance, a patient may be overweight, taking medication for migraines, and has had a few claims for treatment for depression. The Health-e-Life program pulls together a resource library for the patient and develops a personalized care plan that is likely to include a weight management program and encouragement to see a psychologist.
I-trax calls its nurse case managers "nurse mentors." They work with the patients and encourage them to enroll in the mentor program rather than choosing self-care.
People with active diseases who need high-intensity interventions have a one-to-one relationship with the nurse. They are able to call the care communication system whenever they need to talk to their nurse.
Prospective health planning
The I-trax care coordination platform brings together physicians, nurse case managers, and patients, Palumbo says.
"Our system allows all providers to work together seamlessly by giving them data they couldn’t get in another system," he says.
When patients are seeing more than one physician, there is no way for Physician One to know what happens when a patient sees Physician Three unless the patient brings the entire chart along, and the physicians don’t know if a patient is compliant with the treatment plans they prescribe, he says.
Once a patient enrolls in the Health-e-Life program, I-trax compiles a list of all the physicians and contacts them.
I-trax shares any patient information it compiles with all of the physicians who are treating the patient. For instance, if a prescription was ordered and filled but not refilled, the system issues an alert that notifies the physician by telephone, mail, or through the Internet, whichever way the physician chooses.
"We are the only entity that can send lab data to all physicians. It is not legal for the laboratory to send the data to anyone other than the ordering physician," Palumbo says.
The nurses are assigned by employer group.
"Each employer group has their own issues, and some have their own interventions," Palumbo says.
The system generates a task list for each patient every day and automatically sends any information the patient or physician should be receiving. The members decide how they want to be notified.
I-trax uses an interactive voice system that patients can use to report weight, blood sugar levels, or other data.
If the patients don’t call in when they’re supposed to, the system alerts the nurse, who calls them. Physicians are alerted when there are problems, such as a sudden weight gain in a patient with congestive heart failure.
"This is a fundamental shift to prospective rather than reactive health planning, supporting physicians like never before," Palumbo says.