Value-Based Care Hard at Work in Connecticut

In August 2018, a 51-year-old veteran was admitted to the emergency room at Saint Francis Hospital and Medical Center in Connecticut. Alex* had congestive heart failure, chronic kidney disease and a number of other ailments, plus he was in serious pain.

His pain was due to a recent procedure, and even though he had nurses visiting him at home, he did not have any physical therapy in place to aid his recovery. Further complicating his situation, Alex ran out of his nutrition drinks and was unable to afford more. He also lacked reliable transportation, which prevented him from getting to all of his appointments. 

People with complex health issues and multiple ailments frequently do not have the support needed to access proper care and may be overwhelmed when trying to find help. For Alex, that uncertainty resulted in five emergency room/inpatient visits within a four-month period.

But that all changed when he was introduced to a care management program through Saint Francis Healthcare Partners (SFHCP) in Hartford, CT.

The Saint Francis Healthcare Partners’ Population Health team contacts patients within two days following health episodes to review discharge instructions, prescribed medication and offer additional support to the patient.

This program is part of SFHCP’s value-based care model, which helps promote better health, better care and lower costs. By putting the patient at the center of the care experience and paying for quality and results, rather than how many tests are ordered or treatments are provided, value-based care encourages a more coordinated approach to supporting people’s health.

“Saint Francis Healthcare Partners has long had a tradition of innovation in healthcare. Seven or eight years ago, we began a journey to focus on value-based contracts and leverage our experience to lower the cost of care for our patients while not losing sight of our aim to improve the quality of care,” said Ron Kimmel, MD, vice president and chief medical officer, Saint Francis Healthcare Partners.

SFHCP also offered an RN Navigator program in which a member of the organization’s population health team works with the patient to understand available resources and programs to support their health.

The RN Navigator program pulled all the pieces together for Alex. He was enrolled in physical therapy services through the Visiting Nurse Association, they picked up his nutrition drink and helped him explore transportation options through the VA and his insurance plan. They also included their Integrative Medicine unit to help with pain management and referred Alex to local farmers markets and churches for help with meals.                                                                                             

Since engaging with care coordination through Saint Francis Healthcare Partners, Alex has not had a single emergency room visit or inpatient admission. He has attended acupuncture sessions at Integrative Medicine, has reported better sleep patterns and is experiencing decreased pain levels. He also hasn’t missed a single follow-up appointment since his hospital discharge.

UnitedHealthcare and Saint Francis Healthcare Partners have collaborated for years on ways to improve care coordination and enhance health services. Together, the two organizations launched an accountable care relationship that has benefited more than 13,800 Connecticut residents enrolled in UnitedHealthcare’s Medicare Advantage, employer-sponsored and Oxford health plans.

“Our relationship with Saint Francis Healthcare Partners is the perfect example of the difference value-based care can make in a community,” said Stephen Farrell, UnitedHealthcare of New England CEO. “We are really trying to make a difference locally, helping people live healthier lives at a lower cost, and this collaboration has allowed us to do that.”

The relationship between UnitedHealthcare and Saint Francis Healthcare Partners expanded in 2018 with the health system’s participation in UnitedHealthcare’s NexusACO health plan. The plan offers patients access to care providers known for delivering quality and efficient care, often resulting in better health outcomes and lower costs. Currently, there are four employers in Connecticut with 2,000 total members enrolled in NexusACO.

This collaboration continues to shift Connecticut’s health care system to one that rewards quality and value instead of the volume of procedures performed.

*The member’s name has been changed to protect his identity.