The US Family Health Plan’s patient-focused approach that emphasizes and incentivizes lasting patient wellness is unique among health care options in the Military Health System.
Dr. David Howes, president and CEO of member organization Martin’s Point Health Care in Maine, explains how the US Family Health Plan establishes a population-based approach to patient care for each of the nearly 150,000 military family and retiree members across the country.
“The US Family Health Plan believes in a concept called population health, where you know and understand all the people for whom you are responsible and your monitoring their health and their healthcare and their results to be sure they are getting their needs met…As we enroll members and as we take care of members who are enrolled, we work very hard to make sure we understand their health and health conditions and their health needs,” Howes says.
The six member provider organizations that make up the US Family Health Plan operate a capitated-care model in which they are reimbursed at a fixed rate for the cost of all patient services. The provider organizations are responsible for any costs of care that exceed this fixed rate. This arrangement enables significant investment in population health and disease management programs that help people live healthier lives and avoid expensive episodes of inpatient care.
“The US Family Health Plan incentivizes wellness instead of incentivizing illness because it is in our interest for our patients to remain well. This keeps people out of the hospital; it keeps people away from major health needs. We spend a lot of time trying to understand all the aspects of people’s health who are the members of our plan and to prevent them from getting sick, rather to treat them when they become sick,” Howes adds.
The US Family Health Plan’s preventive health care initiatives, including disease and complex care management programs and a patient-centered medical home concept that includes in-home patient monitoring, keep members active in lifestyle programs and invested in their health and wellness. This model of care falls closely in line with recent requests by Congress to reform the Military Health System and contributes to keeping US Family Health Plan members satisfied with their health care, out of the hospital and able to experience a high quality of life.