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.