In contrast to an ailment like diabetes or asthma, where there are significant numbers of patients and the prevalence of the ailment is quite high, Accordant Health Services focuses on complex, chronic diseases that require ongoing, specialized care whose patient population prevalence is low. Although Accordant currently handles disease management for approximately 10,400 patients across numerous health plans, this constitutes less than one percent prevalence among the total patient population of these health plans.
The 15 diseases for which Accordant offers programs have something in common -- they are relatively rare but are associated with very high healthcare costs. For payers, who must seek effective ways to reduce their operating costs, it's not cost effective to spend resources and time designing a program for a small number of patients. As a result, people with these rare chronic diseases often struggle within a healthcare system.
Steve Schelhammer, president and CEO of Accordant, realized the healthcare delivery system didn't effectively address the special needs of these patients and founded Accordant Health Services in 1995. Today, while the patients in the Accordant system receive excellent care, Dr. Richard Hodach, vice president of medical affairs at Accordant, reports that the HMOs or other payers that outsource to Accordant realize a cost savings of 15% - 20%.
Proactive Monitoring Is Key
Accordant's patient services are addressed primarily through a call center with a Web option for the materials. The Web site offers an interactive, educational community for each of the 15 diseases. Although individuals not covered by Accordant's services have access to a portion of the programs in those communities, patients whose payers outsource disease management processes to Accordant have a wealth of services available within the "Personal Health Manager" for each patient.
Accordant's call center is comprised of special teams for each of the 15 disease states: a disease manager, a case manager, a social worker, an LPN to interface with the doctors, and an administrative person. All team members are nurses. The disease manager, a registered nurse, heads the team and maintains a continuing relationship with the patient.
"We proactively approach each patient at least once a quarter, more often if necessary," says Hodach. "We are very preventive in our approach. We look for risks -- things that patients don't want to have happen, and things that are costly when they do happen. If we can identify somebody who is at risk for a fall or who is at risk for a urinary tract infection, for instance, then we can intervene at the time of the risk to minimize the incidence or complications."
"If somebody is unaware of the early symptoms of a urinary tract infection, the problem can quickly escalate," explains Hodach. "Patients need to be educated about early intervention strategies. A regimen of antibiotics at the onset of a urinary tract infection may avoid a trip to the emergency room or a hospital admission. This is especially true with multiple sclerosis patients, who may develop a neurogenic bladder, which puts them at a higher risk for contracting a urinary tract infection."
If a patient becomes very sick or has a number of complicated issues, then the case manager or social worker and other team members work more closely with the patient to try to resolve issues more efficiently. The team approach works well for patients, who develop strong relationships with the nurses on their team. Accordant's approach consistently receives a very high satisfaction rate from its patients.
The call center is staffed during normal workday hours for a high volume of both incoming and outgoing calls, but various individuals are on call to provide 24x7 service. The service also includes a "Nurse Chat" option for online communication. When a patient clicks on that button on the Accordant Web site, it immediately dials a nurse; but instead of a nurse picking up the phone to talk, a private one-to-one chat box comes up so patient and nurse can chat privately over the Internet.
The entire Accordant program for patients consists of the call center, the tools on the Web site and monthly print publications. CEO Schelhammer is a former teacher and believes in the power of education. The Accordant approach educates the patient toward self-oriented behavior and educates the health plan payer in how to achieve better outcomes.
Each community on the Web site includes an extensive library of articles about all aspects of each of the 15 diseases, as well as articles about living with the disease, how to communicate with the doctor and how to communicate better with the Accordant team.
There is also an interactive forum with live presentations over the Internet from medical experts. The patients can hear the expert, see the slides during the broadcast and obtain more information by typing their questions. The medical expert then responds in voice to the typed question. More importantly, this forum triggers a report to the nurses as to patient issues that may require a transfer to a social worker or to a case manager. It also triggers notifications to be sent to physicians.
Outsourcing Investment Pays Off for Payers
Dr. Hodach says the return on investment for Accordant's services is 75% or higher. He describes the company's services as "an independent operation that is designed to work with a payer's in-house system." As part of the implementation process, Accordant works with the payers to develop workflows and processes and then modifies Accordant's products and services to communicate to specific health plan internal operations.
Payers sign agreements for one or multiple years, detailing the services and the number of reports to be delivered. Reports include such data as the number of people enrolled, quarterly assessments, outcome reports on quality and clinical measures, as well as outcome reports on cost measures.
Accordant identifies patients with these 15 diseases by running its patented algorithms against a health plan's claims data. Once those individuals have been identified, they are contacted and enrolled in the Accordant program. From that point on, the patient's data resides only in the Accordant database. Because the payer usually does not have appropriate disease management programs built into its systems, it cannot enter patient data for people with these high-risk, low-prevalence diseases.
By outsourcing and transferring the control of its disease management processes to Accordant -- which specializes in the complexities of care and risk management for rare diseases -- a payer reduces both the up-front investment in resources to handle these programs and also reduces the magnitude of ongoing medical costs it must pay out. It's an ideal win-win-win solution for the patient, the payer and the outsourcer.
Lessons from the Outsourcing Primer:
- A payer can achieve a sizeable reduction of ongoing medical costs if it outsources disease management processes to a company with core expertise and resources built for those diseases.
- Staffing a call center with nurses and other highly skilled professionals raises the operating costs of a center; outsourcing to a company with the resources to leverage in this area makes it affordable for a client.
- When operational efficiency and reduced operating costs are organizational goals, outsourcing presents a high-quality solution.