INFORMATION FOR
HEALTH INSURANCE PLANS
VillageHealth Offers Answers for Heath Plans
Q. Why should I outsource disease management to VillageHealth as opposed to doing it in-house?
A. Given that ESRD is a low-incidence, high-cost disease, your plan may not have enough patients to justify the expense of developing an in-house program. In addition, you may not have the right personnel with the necessary expertise in-house. If not, they will need to be recruited, hired, and trained.
Q. How is the "field-based" VillageHealth program different from "telephonic" programs?
A. In VillageHealth's field-based program, our nurses are based in the local communities of the patients they serve. Therefore, rather than only contacting patients over the phone, our nurses actually visit the patients in person-in their homes, at their physicians' offices, or at their dialysis units.
Q. What has been your experience obtaining buy-in from providers for the VillageHealth program?
A. Once the program is explained to providers, our experience is that they are eager to support it. We've found that providers look upon the VHN as an adjunct to their practice. The VillageHealth program brings them a qualified nurse who can make sure the patient's care plan is implemented and who can stay on top of the patient's needs.
Q. How do patients benefit from the VillageHealth program?
A. Patients benefit by having their own personal nurse to help coordinate care. The VHN is able to assist the patient in getting referrals from their PCPs and prior authorization approvals from the health plan. The VHN can help patients maximize their pharmacy benefits. The patients get an advocate in their corner, someone who is coordinating the implementation of their care plan and making sure that all care providers are on the same page.
In addition, most patients view their VillageHealth nurse as a friend and advocate; as someone willing to listen to their healthcare issues with a sympathetic ear and the ability to solve some of the problems that make living with chronic kidney disease more difficult.
Q. What services do you offer for patients who are not yet at end-stage renal failure?
A. VillageHealth does indeed have a program for chronic kidney disease patients who are not yet on dialysis. This program has medical management guidelines that stratify the patients into an appropriate CKD stage, depending on the level of kidney function.
The most exciting opportunity in the long term is to reduce the incidence and prevalence of ESRD through aggressive population management of those CKD patients in the early stages. Since diabetes, hypertension, and cardiac disease are primary precursors of progressive renal disease, we would propose to integrate with those programs you may already have in place to reduce the cost and delay the progression of CKD to ESRD.
With trained VillageHealth nurses coordinating patient care, we can provide the education and tracking that these CKD patients require. Most CKD patients have three to four comorbidities by the time the CKD is detected, and these are difficult to manage. Combining an ESRD and CKD program through nephrology leadership, with the use of clinical guidelines, allows for a seamless program of patient management.
