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Mobile coordinator adds personal touch to union local's health care

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PALM SPRINGS, Calif. — Facing rising health costs and failed efforts to control those costs, one union local opted to bring health care management to the patient's bedside and home.

In the past, the Philadelphia-based Teamsters Local 830's disease and case management was handled by telephone and failed to inspire engagement from the union's 1,800 members and their families, said Samuel Kenish, administrator of the local's employee benefit funds.

“We have tried … helping members make important decisions about where their care is delivered and managing their health, and despite our best efforts, the results have traditionally been very disappointing to us,” Mr. Kenish said Monday.

So the union local that primarily represents beverage company workers decided to get personal, he said during a session at the Pharmacy Benefit Management Institute's Drug Benefit Conference in Palm Springs, California.

In September 2013, the local implemented the Mobile Care Coordinator program, a health advocacy and case management effort in which a registered nurse personally interacts with ill union members to achieve better health outcomes.

“We decided that we needed to position someone with a clinical background in a place where we could get buy-in, where we could gain trust, and where folks could get the help they need at the time they need it,” said Mr. Kenish, who is based in Philadelphia.

The union is notified by its health insurer when a member is hospitalized, and the mobile care coordinator, who works for the union rather than the health insurer, goes to the hospital to help members understand their diagnosis and treatment plan. The union has one mobile care coordinator managing acute care and another focusing on chronic conditions.

“We first build trust by engaging with folks when they have a situation occur that is acute,” Mr. Kenish said. “They are going into the hospital, they've just done a new complex diagnostic test to decide whether they have a significant disease, and we get to interact with them at that time when they really need help.”

The mobile care coordinator also follows up with union members at their homes, goes with them to their doctor appointments and performs outreach to help them manage chronic diseases, which is “where all the money is getting spent,” Mr. Kenish said.

Integrated data plays a large part in the success of the program, Mr. Kenish said.

“We get streams of information not only from the medical provider but also from the (pharmacy benefit manager), and when our nurse does outreach to our member, they know what their drug claims experience looks like, they know what their medical claims experience looks like, and we can interact with the PBM and with the medical provider around a variety of issues,” he said.

In the first year of the program, 1,161 cases were opened with the mobile care coordinator for 1,077 unique union members. The next year, about 2,000 cases were opened and another 600 unique members were added.

Before the mobile care coordinator was implemented, its health insurer that had been conducting case management had only two of the union members “on their case management radar,” Mr. Kenish said.

In the first year, the union, which has about 4,500 people covered by its benefits, saw a 9% reduction in medical claims spending, he said.