Care Coordination

What is care coordination? Ask a hundred people and you’ll get a hundred answers. For Healthcare Highways Health Plan it’s simple – care coordination means providing our members with a better healthcare experience by collaborating with our network providers to design and provide the tools and actionable data they need to deliver better care to every member every day.

Our role is to strengthen appropriate and timely engagement between the primary care physician and the member so that members get the care they need at the right time and place. Practical applications include:

  • Helping primary care providers address broader healthcare challenges by providing them with timely, accurate and actionable clinical data
  • Engaging care coordinators to motivate individuals, help them navigate the healthcare journey, and reduce barriers to health
  • Establishing defined care pathways based on each member’s health risk
  • Measuring health care results and rewarding providers as our members get healthier.

Unique to Healthcare Highways is our solution for increasing providers’ efficiency and ensuring quality outcomes that reduce the total cost of care. Here are three examples.

Direct negotiation and engagement with providers

We contract with providers who believe as we do: health plans should be collaborative

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Data insights that empower managed care

We believe that care coordination is most effective when primary care providers and their care teams engage directly

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Risk-sharing by providers

Providers participate in bonuses for both practice efficiencies and quality outcomes.

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Direct negotiation and engagement with providers

We contract with providers who believe as we do: health plans should be collaborative, flexible and support progressive ideas that have the potential to improve the health of our members without being prescriptive. Some of our networks limit participation to providers with a track record of improving quality and lowering the cost of care. This allows us to focus resources on our core values:

Providing on-going support tools, data and resources to our care teams and members, enabling them to make better care decisions. Providing more timely interventions on identified health problems of our members, tackling identified health risks earlier to avoid or reduce the occurrence of major health events.



Data insights that empower managed care

We believe that care coordination is most effective when primary care providers and their care teams engage directly with their patients assisted by our supporting role. We also understand the importance of flexibility when meeting providers where they are in their own understanding of patient engagement. This means that care coordination sometimes is performed by Healthcare Highways Health Plan through our care coordinators and other times we leverage innovative and successful care coordination programs established in provider practices.

Member engagement can be telephonic, or face-to-face at a workplace, home, or other appropriate setting. In focusing on each member and keeping healthcare personal, care coordinators can positively affect the health of our neediest and most at-risk members. Our team provides feedback to the primary care providers of those members when appropriate to advance better care through communication and collaboration.



Risk-sharing by providers

Providers participate in bonuses for both practice efficiencies and quality outcomes.

Bonus Measurement: Efficiency.

Providers who manage their patients’ health with quality care at a lower aggregate cost than the market average (after risk adjusting for health differences) receive an annual financial bonus for each panel member.

Bonus enhancement: Quality.

Ten key metrics, ranging from immunization compliance to cancer screenings to controlling diabetic and hypertension scores are also considered when determining the bonus amount.


Diabetes Management

Healthcare Highways Health Plan provides members who are diabetic with an FDA-cleared* meter that allows the care team to track glucose readings. In this way, the employee can get immediate feedback after each blood sugar reading without the tedium of manually logging results.

Certified diabetes educators provide highly personalized support and set goals for each patient based on their unique medical needs, eating habits, food preferences, and exercise routines.

Our program connects everyone who can help a member manage his or her condition—healthcare professionals, clinical services, educational resources, and the member’s network of family and friends.

* FDA clearance does not imply approval.