The URAC Report

When Hurricane Harvey slammed into Houston in August, pounding the city with powerful wind gusts and several inches of rain, Community Health Choice (CHC) was ready. “I’ve lived through three hurricanes,” says native Houstonian Delwin Beene, director of accreditation at CHC. “This wasn’t our first time at the rodeo.”

On April 19th, President Trump signed into law (S. 544) extending the Veterans Choice Program which allows some veterans to receive healthcare from local doctors and hospitals.  The legislation passed with broad bipartisan support – the bill was approved, by voice vote, in both the House and the Senate.

I once had a local politician tell me that a poll reflects the mood of the particular day it was taken and often ends up wrong in the end. For him, people were fickle and he wouldn’t let one poll dictate his fate.

As the Department of Veterans Affairs (VA) prepares to award contracts for managing its Community Care Network in four regions nationwide, organizations should keep in mind the importance of delivering sustainable, local healthcare solutions.

There’s a changing philosophy in health utilization management today, away from simply thinking of it as a cost-containment approach and more toward using it as a proactive tool to achieve the oft-repeated mantra of the right care for the right patient at the right time. Data and automation are increasingly being used to make that shift possible, while also putting greater power in providers’ hands to make medical decisions.

Health plans are increasingly seeking ways to cement partnerships with the providers in their networks, helping to provide tools that will allow them to survive and thrive in the move toward value-based care. At the top of that list is leveraging the enormous amount of data that payers have available and putting it to use to make it easier for providers to do business with them.

It is no secret that the Department of Veterans Affairs (VA) has faced tremendous challenges providing our nation’s veterans with access to the timely, quality care they deserve.

Patient experience plays a big and increasing role in measures of quality, accounting for eight of CMS’s 34 quality care measures for ACOs, for instance. That’s why many providers and health plans are taking steps to make sure their call centers enhance patients’ satisfaction rather than leave them hanging up in frustration. 

“It’s just like with any customer service line, if we have to wait on hold forever, it leaves a bad taste in your mouth,” said Bonnie Zickgraf, integrated services manager for URAC. “Plus, with social media, the bad experiences are 10 times more magnified than the positive ones.”