Feet on the Street

UnitedHealthcare Launches Neighborhood ConnectionsThere is comfort in familiarity. For some of Tennessee’s most vulnerable citizens, a familiar face is now available to help them navigate a confusing … and often overwhelming … healthcare system. At the end of 2013, UnitedHealthcare launched the Neighborhood Connections™ program, taking care coordination into the neighborhoods where many of their TennCare members at highest risk for serious health complications live. The managed care organization has opened health assistance centers in key areas of Knoxville, Memphis and Nashville and hired care coordinators from within those neighborhoods to help members access needed health services, as well as community resources.Darren Hodgdon, chief operating officer for UnitedHealthcare Community Plan of Tennessee, said the impetus behind the ‘feet on the street’ approach was multifactorial — from meeting higher expectations of care coordination and reducing avoidable hospitalizations to ensuring members understand their benefits and increasing awareness of other resources to help improve members’ health and overall quality of life.   Achieving those goals would be impossible, however, if the health plan couldn’t find a way to reach the targeted members. Hodgdon said some of the most vulnerable individuals in the TennCare population are passively enrolled in their health plan during a hospitalization and don’t really know or understand their benefits. “When you are sick and challenged by everyday life, you can’t think proactively about your health … you’re just trying to survive,” Hodgdon pointed out. “To get these members into the system to have better access to primary care, we’ve got to be in the market … we’ve got to be in the neighborhoods.”In choosing the physical location of the health assistance centers, Hodgdon said UnitedHealthcare relied on technology to pinpoint areas where members had gaps in care and frequent emergency room visits. “Those with the highest gaps in care have the highest propensity to have an acute event,” he explained. While geo mapping highlights a hotspot neighborhood, actually locating those in need of the program can be a challenge. Some members have prepaid phones or no phone at all, and many of them are transient. Often, they have significant socioeconomic challenges and complex conditions including mental illness.“It’s very difficult to reach these members by simply picking up the phone,” he said, “but they need better coordination between episodes of care.”By hiring coordinators from within the target neighborhoods, UnitedHealthcare gives Community Plan members a familiar, trustworthy contact and gains insight and institutional knowledge into the local environment and barriers to accessing care. Taking a ‘whole person’ approach, the coordinators visit with individuals to get a big picture view of their life including current health status, religious and cultural preferences, living conditions, financial issues and behavioral health concerns.Working with the company’s physical and behavioral health providers, the coordinators help identify at-risk individuals who might qualify for the extra level of service and act as the point person to help that individual set health and self-management goals and create and implement physical, emotional and social support plans. Hodgdon was quick to say the program wouldn’t have the chance to succeed without the community partners who round out the infrastructure by providing a range of services from warm meals and shelter to transportation. UnitedHealthcare has hired 12 coordinators, four in each market, to reach a relatively small group of people accounting for substantial cost. “In Knoxville, 1.8 percent of the members represent 37 percent of my total spend. Within that group, 335 members accounted for $24 million in total medical spend with the average cost exceeding over $70,000 per member,” Hodgdon said. He added the current environment isn’t sustainable for anyone. Instead of just serving those in the waiting room at the local ER, UnitedHealthcare Community Plan hopes to proactively intervene with those at greatest risk before problems escalate to the benefit of everyone involved. “We’ve got to address the social and emotional challenges people have. If those things aren’t addressed, you’re not going to be able to move the needle (on health outcomes),” Hodgdon said. “I think what’s unique is we’re doing it as a health plan. It shows the sea change that’s happening … that accountability is taking hold.”