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Care coordination and healthy, productive employees

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Companies are getting increasingly involved with their employees’ health care as they strive to keep them healthy and productive.

Officials at hospitals and insurance companies say employers are taking advantage of the benefits of care coordination, which brings together doctors, hospitals and health insurance companies to communicate and deliver better care.

Companies – with the help of providers (health care facilities) and payers (insurers) – can offer services to employees such as preventive care, wellness programs, health screenings and fairs, ergonomics training and behavioral health consultations.

“We have redesigned the system between payers and providers with care coordination, and now is the time to show employers what we can do for them,” said Dr. Nina Taggart, senior medical director of accountable care for Lehigh Valley Physician Hospital Organization Inc. in South Whitehall Township.

LVPHO, a preferred provider organization aligned with the Lehigh Valley Health Network, uses data from Populytics to coordinate care.

Populytics, a wholly owned subsidiary of LVHN, analyzes insurance company claims and electronic medical records to gain insight about groups of patients. This information is one of the major vehicles that allows providers and payers to work with companies to determine the specific needs of their employees.



Laura Mertz, associate executive director for LVPHO, said employers can work directly with the organization and Populytics or can coordinate with a broker or insurer to establish services to offer employees. Mertz said the data analysis can give employers a mirror into what services are most needed.

The health network has created a platform that streamlines clinical metrics across a network of providers so that two patients with different insurers are treated the same, she said.

“There is a fee for employers, but Populytics offers programs such as ergonomics training to employees. They may go out to a company and do health fairs or blood-pressure screenings,” Mertz said.

“Populytics can visit with employers and set up a yearlong wellness program. We can recommend routine screenings, establish a fitness plan or a tobacco cessation program.”


Reading Hospital, one of five hospitals under parent company Tower Health, partnered two years ago with UPMC Health Plan, an insurance provider. The venture gives hospital employees affordable health care plans tailored to specific needs, and the UPMC Health Plan also markets its products and services to employers throughout Berks County.

The insurance provider encourages employees to go to Reading Hospital for care.

“We are able to meet the needs of employers and offer them affordable health benefits, including smaller employers,” said Clint Matthews, president and CEO of Tower Health and Reading Hospital. “We help them manage costs and provide benefits to employers.”

UPMC, the hospital and the employer establish employer services based on claims data and medical records.


Kimberly Cepullio, president of UPMC commercial products at UPMC Health Plan, said employers are designing wellness programs so employees are given “robust incentive programs,” and they can use services such as screenings for diabetes and cancer, consult with a behavioral specialist or reduce stress through exercise and eating right.

Steve Babcock, a sales director at UPMC Health Plan, said much of the time an employer uses a broker to coordinate the insurance plan with UPMC.

Matthews said Reading Hospital employees get routine wellness checks, and the hospital recently distributed Fitbits and performed behavioral health screenings.


One of Lehigh Valley Health Network’s care collaborations is with Highmark Blue Shield, according to Dan Day, regional vice president of sales at Highmark.

Lehigh Valley Flex Blue, as the insurance plan is called, provides two levels of in-network benefits.

“Employers offering Lehigh Valley Flex Blue can see cost savings when employees access care through LVHN health care providers and facilities,” Day said.

“Employers also benefit from healthier employees through better care coordination between Highmark and LVHN – including managing chronic illnesses such as diabetes, heart disease and asthma – so employees miss fewer days of work and are more productive.”


According to Day, Highmark claims data show employees enrolled in Lehigh Valley Flex Blue are more likely to get preventive services such as immunizations and physical exams than those with a standard PPO insurance plan.

He said employees who have the Flex Blue plan have 39 percent fewer emergency room visits and 20 percent fewer surgeries than members in standard PPO products.

In addition, there is a 6 percent savings on overall medical and prescription costs as compared to the PPO plan.

“Those are significant savings – especially for smaller employers that are committed to maintaining quality health benefits for their employees,” Day said.


Taggart said it all goes back to the new health care collaboration and the ability of all parties to look at data analysis for an employer.

“It helps to understand how the shared population (at a company) is performing and their needs.

“Why are folks missing work? Do they have stress that we don’t know about?” Taggart said, citing wellness programs as a way to get in touch with employees.


A wellness program can be set up online, employees can work with a coach to help with issues such as managing stress, finances and personal situations.

Taggart said she recognizes employees must be offered an incentive to participate in the wellness program.

“It doesn’t work if an employee says, ‘My company made me do it,’ ” she said. “The side effect to all of this is a healthy workforce, which is a great side effect.”

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