Q&A

Q&A: An Interview with Chairwoman Linda Marzano

We recently sat down with Linda Marzano, the new chair of the board of directors for the US Family Health Plan Alliance. Linda will lead the Alliance as Congress is exploring reforms to TRICARE and considering the recommendations made by The Military Compensation and Retirement Modernization Commission in February 2015. Linda, the CEO of Pacific Medical Centers, shares with us her views about the value of the US Family Health Plan program:

 

Q: Your responsibilities at PacMed include overseeing a US Family Health Plan (USFHP) that serves the Pacific Northwest. What were some of your first observations about working with TRICARE and the military healthcare system?

A: What stands out immediately is the commitment to and trust of PacMed by our patients, some of whom have been with us for 15 to 20 years and have wonderful partnerships with their physicians. Many USFHP beneficiaries have had long-term relationships with us—some since the 1980s, before the Plan’s inception, and others who have been with us since Congress created the USFHP and later designated it as a TRICARE program in the 1990s.

I’ve also noticed that unlike some other patient populations I’ve encountered, our patients really listen to their doctors and follow their professional advice. I attribute that, at least in part, to a respect for authoritative expertise forged by their military backgrounds. Our military health patients are also very open to giving us feedback about their interactions with our staff—from how they were greeted to the processes in our clinics—which allows us to continually improve. I very much appreciate that two-way relationship.

 

Q: What is the USFHP approach to working with a patient?

A: We place a lot of value on the relationship between patient and provider. The aggregate patient satisfaction score for all US Family Health Plan programs is substantially above the average for the Department of Defense. We work very hard on patient access initiatives. When a member joins our Plan, our concern is not just about what the member comes to see us for on one particular day. We take a comprehensive approach, considering everything else going on in their lives. What is their family situation? What about their job? What geographic area do they live in? By working with our patients holistically, there is a much better relationship between the patient and the healthcare provider and ultimately better health outcomes. If a patient wants to come in on a given day, we will get them in on that day. It’s always about the patients, all the time.

 

Q: How is technology helping innovate the way USFHP offers its service?

A: Innovative uses of Technology lets us put healthcare on the patient’s terms. Patients can’t always come to the doctor’s office. If it is 10 p.m., your husband or wife is deployed and you have a sick child, it is not manageable. Technology provides an alternative to packing everyone up and heading to the emergency room. We have to be able to use technology in different ways to support healthcare and the demands of the people.

 

Q: USFHP focuses on improving patients’ abilities to manage their own healthcare, which is especially pertinent for management of chronic diseases like diabetes. How is USFHP using preventive care programs to address chronic disease?

A: One of the biggest trends in the healthcare industry right now is a desire by patients to have more control of their healthcare. At USFHP, we are embracing that. When we take a collaborative approach to managing chronic diseases, we can reduce the rate of hospitalization and doctor visits and can also avoid prescribing additional medications that may be required if a condition is not caught early enough. We also focus a great deal on screening and prevention. Take for example our colon screening and all of our cancer screening initiatives. We channel time and energy into our outreach because we want to catch those things early and keep those patients healthier. 

Truly effective preventive care requires attentiveness to patients’ degrees of risk. Our care managers and case managers are trained nurses and social workers who conduct regular outreach to patients. We evaluate all of our patients and identify those we consider high-risk who would benefit from more frequent follow-ups. Once those patients are identified, we work with them on a regular basis to share helpful information related to their health through mail, phone calls and even group meetings.

 

Q: Why has USFHP invested so much in preventive medicine?

A: We know that keeping patients healthy and putting these prevention measures in place helps patients lead better lives. We identify problem areas through evidence-based medicine. We put these programs in place because of our belief in patient-centered medical home and chronic disease management and evidence-based medicine. We want to keep people healthy, we don’t believe in only seeing patients when they’re sick. We want to keep them out of the doctor’s office and out of the hospital, so that’s what led to developing the infrastructure to do the outreach when the patients need it and do outreach to help patients not even need that care.

 

Q: Does the capitated model encourage this type of investment?

A: Absolutely. In a fee-for-service model, a provider is paid when the patient walks through the door, which encourages illness instead of prevention and wellness. With a capitated model, like USFHP features, there is an incentive to institute cost-saving measures. If a plan is able to reinvest in staff or new technology it can operate more efficiently with fewer costs. One example is USFHP predicative modeling, which we use to determine a patient’s risk factor, this helps us prevent problems and keep patients healthy.

 

Q: What lessons have you learned from working with USFHP?

A: We have taken away some great lessons from USFHP and applied them at PacMed, so our commercial patients are enjoying the same benefits. USFHP has a unique capitated model, and we are constantly reinvesting in the program’s infrastructure to support the highly effective case management programs and personnel we have in place (e.g. the social workers, the outreach and the chronic disease management programs).The approach is so effective that we now apply the same care model to our commercial patients at PacMed. Since adopting the new model from USFHP, we’ve lowered our costs by 10 to 15 percent, and our healthcare outcomes are in the top quartile on the Washington Health Alliance website.

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USFHP Programs That Are Heading Off Expensive Chronic Care

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US Family Health Plan features more than 40 disease management programs and a variety of complex care management programs.

Chronic disease comes at a high cost. The Centers for Disease Control and Prevention estimates that 86 percent of all healthcare spending in 2010 was due to one or more chronic medical conditions. For example, $314 billion is spent every year in the U.S. to combat heart disease and stroke. However, early detection and ongoing management of such cardiovascular conditions can make a real difference for a patient’s quality of life while helping save money. Similarly, according to the National Institutes of Health, being overweight significantly increases the risk of serious illnesses such as heart disease, high blood pressure, Type 2 diabetes, gallstones and certain cancers.

To improve overall health, US Family Health Plan features more than 40 disease management programs and a variety of complex care management programs. USFHP was also one of the first plans to implement a patient-centered medical home concept, with benefits like 24-hour nurse helplines and in-home patient monitoring. The results? USFHP beneficiaries are experiencing improved health and wellness and require fewer emergency room visits or hospitalizations.

USFHP health plans have developed and adopted a number of health education and care management programs in an effort to help prevent the development of costly chronic diseases. For instance, Heart to Heart—a 4-day class that raises awareness and educates patients about heart disease, stroke and its related health conditions—teaches patients how to manage their risk factors through assessment tools. The weight management program MOVE!—originally designed by the Department of Veterans Affairs—is uniquely tailored to each participant and emphasizes behavioral and lifestyle changes like regular exercise and healthy eating to help patients manage their weight.

We’re proud to offer America’s military families industry leading programs to prevent expensive chronic care. Click here to learn more about the many wellness programs available to our beneficiaries.

Quality Healthcare Driven by Innovation

We are continually inspired by our beneficiaries and the innovation of the branches they served.

Mike

Mike represents why US Family Health Plan is proud and committed to delivering comprehensive, innovative healthcare to retirees and their families.

Take Mike, a retiree and longtime USFHP member. He has been with USFHP for more than seven years after a career of service in the U.S. Air Force. Mike and his wife live on a pension and, with rising healthcare costs affecting families across the country, deserve the benefit of the latest medical infrastructure and technology to ensure quality and keep costs down.

Mike represents why US Family Health Plan is proud and committed to delivering comprehensive, innovative healthcare to retirees and their families. We are leaders in preventive health techniques that reduce the risk of common health issues and the development of new technologies that improve patient outcomes in a number of ways.

 

  • US Family Health Plan was the first TRICARE provider to emphasize virtual care support through a 24-hour telephone health hotline, giving patients around-the-clock access to nurses and primary care doctors who can offer general health information, self-care instructions, assistance scheduling next-day clinic appointments and advice on whether to use emergency services immediately.
  • Population wellness programs—including flu outreach reminders, weight management programs, smoking cessation programs, health literacy training, osteoporosis screenings, substance abuse treatment, stress management programs and other preventative care services—helping keep members healthy and out of the hospital while also allowing them to invest in their own care.
  • Disease management programs help prevent and manage diseases for treatment while reducing hospital readmissions for care of chronic conditions. Examples include cholesterol management for patients with cardiovascular conditions and blood pressure control and heart monitoring systems for diabetes patients. While emergency room visits are up across the country, USHFP members make fewer visits to the ER than other TRICARE Prime beneficiaries, a testament to the disease management programs, telemedicine and other initiatives used to streamline care.
  • Electronic health records allow care providers to monitor patient vitals electronically. We’re continuing to expand our ability to share patient data and make advances in telemedicine to allow care providers to keep tabs on high risk members and trigger alerts in emergencies—thus making the process of health data sharing across care providers more efficient.

At US Family Health Plan, we will continue to honor the dedication and service to our country that Mike and many of our members have shown by serving as a model for military healthcare providers, staying on top of trends and providing only the best benefits possible. Easy access to high-quality, affordable healthcare ensures members and their families can rest easy, and we look forward to providing Mike, his family and all in the US Family Health Plan fold with continued quality care and a strong physician-patient relationship, driven by innovation.

DOD warns of Tricare mail scam

The Defense Health Agency is warning Tricare beneficiaries of an elaborate mail scam designed to steal money from their banks.

According to the DHA Office of Program Integrity, some Tricare beneficiaries have received letters from a bogus company called Tricare Survey Inc., offering them the chance to work as “secret shoppers.”

The mailings instruct recipients to cash enclosed checks for $3,775 at their banks, keep a percentage of the money for themselves and use the rest to buy six $500 shopping cards to be used at retailers for “secret shopping” excursions.

But when recipients report the card numbers to the company, as instructed in the letters, the fraudsters use the numbers to transfer the amount to their own accounts.

In the alert, issued by the Defense Department on Sunday, August 30, Tricare officials advised beneficiaries not to participate in the scheme, saying they may be held accountable by their banks for the money.

Tricare will identify the checks as counterfeit and return them to the bank in which they were drawn from as non-cashable. Potential exists for the beneficiary to be personally liable for the entire $3775.00, the notification stated.

Companies and individuals target military personnel and families with scams with such frequency that in 2012, federal and state law enforcement agencies created a database of offenders, called the Repeat Offenders Against Military database.

Defense health Agency officials urge anyone who received a secret shopper letter to submit a report to the DHA Program Integrity Office. They can do so online on the office’s web page by clicking the “Report Health Care Fraud” button.

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US Family Health Plan Members Join in Memorial Day Events

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On Saturday May, 23rd representatives from US Family Health Plan member St. Vincent’s Catholic Medical Centers participated in a Memorial Day Event at the BG William C. Doyle Cemetery in Wrightstown, NJ. This event was sponsored by the New Jersey Department of Veterans and Military Affairs and included participation by the New Jersey National Guard Adjutant General, Brigadier General Michael L. Cunniff and New Jersey Lieutenant Governor Kim Guadagno in the parade. All organizations of the US Family Health Plan program honor and remember those who perished in our country’s wars and other conflicts, including the more than 6,800 American service members who gave their lives since Sept. 11, 2001.

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US Family Health Plan Support’s Army’s Operation Recruit Enlist Dinner

US Family Health Plan members support our military in many ways.  On May 12, 2015, US Family Health Plan member Pacific Medical Centers sponsored the Army’s Operation Recruit Enlist Dinner at Saint Martin’s University in Olympia, WA. As the pictures shows, new recruits and continuing service members were treated to dinner in conjunction with their taking the enlistment oath.

Compensation Commission cites US Family Health Plan as Important Example of Population Health Management for DOD

Arlington, VA – The Final Report of the Military Compensation and Retirement Modernization Commission calls the U.S. Family Health Plan (“USFHP”) “An important example” of how to use “nonprice tools to manage patient care.” The commission recommends the US Family Health Plan continue to be among the health care choices available to military families in a new OPM-administered program.

“The Commission has reaffirmed USFHP as a provider of high quality care that improves health and keeps people out of the hospital,” said Jim Schweiter, Chief Executive Officer for US Family Health Plan Alliance. “The Commission’s recognition of USFHP as an example of care management practices that the rest of TRICARE should emulate is very gratifying.”

“Population health management is the direction of future medical care in the United States. We are pleased that the Commission recognized this trend as it considered the future of the TRICARE health benefit,” said David Howes, president of Martin’s Point Health Care, a US Family Health Plan member and chair of the Alliance’s board of directors. “The Commission also recognized the value of the US Family Health Plan in using tools to avoid inpatient admissions, prevent readmissions and shorten hospital stays. The US Family Health Plan is renowned for providing high quality health care to beneficiaries. As everyone familiar with this plan knows, patient satisfaction among its members has long been among the highest in the Department of Defense health care system.”

In its report, the Commission recognized the USFHP program for its use of “population health” managed care techniques which include “disease management, wellness, and better coordination of care.” The commission report notes that compared to TRICARE Prime, USFHP participants, have 33 percent fewer inpatient days and 28 percent fewer emergency room visits than other TRICARE Prime enrollees.

The commission commended USFHP for “identifying high-risk patients, managing complex cases, keeping chronic diseases under control, and promoting wellness and preventative services.” As a result of the success of the USFHP program’s managed care techniques, the Commission recommended that the program continue in the new system of care proposed in its report.

About the US Family Health Plan

The US Family Health Plan is among the health care choices for eligible beneficiaries of the Department of Defense’s TRICARE Prime program. Health care is provided to active-duty family members, including activated National Guard and Reserve family members, and retirees and their family members. Care is provided through large, local civilian health care networks of primary care physicians, hospitals and affiliated specialists. Patients choose a primary physician who provides and coordinates care and referrals to specialists and hospitals. The US Family Health Plan Alliance is the association that represents the collective interests of the regional USFHP networks in interactions with Congress, the Department of Defense, and the private sector.

Contact: Jim Schweiter,

US Family Health Plan Alliance
Jim.Schweiter@usfhp.com

US Family Health Plan Reduces Need for Emergency Care and Hospitalization

The sponsoring organizations of the US Family Health Plan program, highly experienced providers of high quality health care in the Military Health System, have successfully reduced the need for care in two key and costly areas.

The US Family Health Plan is a TRICARE Prime option that focuses on keeping patients well by identifying disease risk early, taking the necessary interventions, and coordinating services through a primary care manager. This managed care approach ensures care is provided in the most clinically appropriate, least expensive, and safest setting.

“The managed care approach used by the US Family Health Plan gives patients the care they need when and where they need it so that they stay as healthy as possible. We do everything we can to optimize patient wellness and to achieve positive long term health outcomes,” said David Howes, M.D., president and chief executive officer of Martin’s Point Health Care, one of the six US Family Health Plans.

According to an independent actuarial analysis, when compared to the TRICARE Prime program as a whole, adult US Family Health Plan members under age 65 spent 33 percent less time in the hospital and visited the emergency room nearly 25 percent less often than other adult Prime members. Thus, US Family Health Plan members utilize inpatient and emergency care less frequently than other TRICARE Prime beneficiaries. Importantly, US Family Health Plan member patient satisfaction rates continue to be among the highest in the nation and among Department of Defense beneficiaries.

“The US Family Health Plan program continues to demonstrate that its innovations, high quality primary and specialty medical care, and attention to customer service add value to the Military Health System,” said Henry J. “Jim” Schweiter, chief executive officer of the US Family Health Plan Alliance. “It is a privilege for the Designated Providers of the US Family Health Plan to serve our uniformed services families. They have sacrificed a great deal for our country.”

About the US Family Health Plan:

An integral part of health care provided to uniformed services dependents and retirees since 1981, the US Family Health Plan program is part of the Military Health System, offering the TRICARE Prime benefit in 16 states and the District of Columbia. The US Family Health Plan was the first and remains the only true population health/managed care model in the Military Health System. The six fully accredited, community-based health care systems, known as designated providers, include Brighton Marine Health Center, Christus Health, Johns Hopkins Health Care, Martin’s Point Health Care, Pacific Medical Centers, and St. Vincent Catholic Medical Centers.

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Salute the Troops

The US Family Health Plan is deeply grateful for the service and sacrifice of the members of the uniformed services, and their families. For the past 10 years, US Family Health Plan at St. Vincents Catholic Medical Centers has been a proud corporate sponsor of the “Salute the Troops” Thanksgiving Day event, which is held on the Battleship New Jersey located on the Camden, NJ, Waterfront. Soldiers training at Joint Base McGuire-Dix-Lakehurst who couldn’t be home with their families were treated to a home cooked Thanksgiving dinner aboard the WWII historic battleship.

“I’ve participated in this event each of the ten years we have sponsored it, ” said Jeffrey Bloom, Executive Director and Senior Vice President of the US Family Health Plan at St. Vincents. “The men and women of our uniformed services, and their families, never cease to inspire me. After all they do for our country, this dinner is one simple way to say thank you,” Jeff Bloom said.

Learn more about the event

Frank G. Willetto, an 84-year-old Navajo Code Talker, renders honors during the playing of the national anthem at a ceremony commemorating the 65th anniversary of the Battle of Iwo Jima at the National Museum of the Marine Corps in Triangle, Va., Feb. 19, 2010. In February 1945 the United States launched its first assault against the Japanese at Iwo Jima, resulting in some of the fiercest fighting of the war.

Veterans Day Message from the US Family Health Plan

On this Veterans Day, the US Family Health Plan salutes the millions of men and women who have served in the United States Armed Forces. America’s veterans embody the ideals upon which America was founded more than 230 years ago.

The 22 million veterans alive today have served in all branches of the armed forces and in conflicts large and small. Our veterans have shown the selflessness, courage and commitment that have kept our nation free and allowed the United States to become the greatest country in the world. America’s veterans have fought our wars, stood ready during peacetime and responded to disasters at home and abroad when called upon. While we can never truly repay the debt we owe these heroes, the least we should do for them is ensure that they have full access to the services and benefits they have earned, including health care.

The member organizations and staff of the US Family Health Plan program are truly grateful for the service and sacrifice of America’s veterans and their families. Today, and every day, we are committed to honoring their service through the delivery of the highest quality health care in support of our men and women in uniform, their families, and retirees and their families.