BRIEFING PAPER
FAMILY HEALTH FOUNDATION
Peer Coaching/Mentoring Project
("the new Welcome Wagon")
Managed Care presents an opportunity to improve the health of covered individuals, but both providers and patients find that its rapid implementation has produced major negative side effects. The behavior changes demanded of consumers by managed care are more profound than policy-makers understood. Communication with the patient population has proved more difficult for both plans and providers. FHF has proposed pilot testing a model that can not only turn this situation around but also reduce costs long term.
Project Description
FHF is prepared to work with Managed Care Organizations to carry out a demonstration project in Bexar County, Texas (and other markets) on peer coaching and mentoring with members of a Medicare HMO (we are concurrently exploring a similar project under Medicaid managed care). This project will show how the investment of a small percentage of capitation payments (estimated at less than 2% for Medicare, and 4-5% for Medicaid) can significantly improve outcomes and reduce certain costs.
Method:
Employing locally recruited, neighborhood based peer outreach personnel (Community Resource Advisors), make periodic home visits to educate on the basic process to access services under managed care; assist in scheduling, reconfirming and following up on appointments; reinforce value of preventive care. The CRA can serve as a kind of "welcome wagon" agent for Medicare HMO members. The strategy specifically includes recruiting peers with similar life experience to enhance the worker’s credibility and her/his ability to establish a trust relationship.Regular home visits by a caring layperson can improve care and help reduce risk by dealing with three of the major contributing factors in high health care costs among the elderly: Falls and other accidents; Depression; and Compliance with provider instructions. The visitor can:
 | Observe and deal with simple home safety hazards |
| Provide social contact and encourage socialization and use of non-medical programs |
| Review and document use of medications and encourage provider communication |
Policy-related outcome objectives
| Improve access to primary care, use of "medical home" and appropriate use of services |
| Increase use of preventive procedures, disease management and early detection of conditions |
| Increase stability/predictability of risk |
| Reduce effects of home injury and depression |
| Reduce acute care expenditures (long term) |
Other significant outcomes
| Reduce rate of missed appointments |
| Improve Patient compliance (especially with medications) |
| Higher Patient satisfaction (= lower liability risk) and loyalty to providers and HMO, leading to decreased "doctor-shopping" and plan-switching behavior |
| Reduce consumer anxiety and confusion in use of health care system, and increase consumers’ sense of control over (health) environment |
Funding:
an adequate scale pilot requires a minimum of $750,000 for the first year from participating HMOs, foundations, hospitals and physicians; we have a number of outside funders interested pending commitment from an HMO.Community support:
FHF has demonstrated capacity to convene all significant stakeholders in the Medicaid market (insurers, providers, community, government) in an Advisory Committee structure already at work. We can easily do so for Medicare. Major support for the model has been expressed at State level by legislative leaders, the Texas Medical Association and hospital associations.Background on the Family Health Foundation: click here