Community Health Choice helps manage complex and chronic care conditions

Reviewed by Alina Shrourou, B.Sc. (Editor)Dec 14 2018

Texans often face crucial health-related decisions without training or guidance. How do we decide when to seek emergency care? What are the warning signs of diabetes? Should we go to a clinic or can we reach someone on the phone? Imagine having a partner or team guide you towards better choices for your situation.

Houston-based Community Health Choice (Community) helps its Members answer these questions and take better and more informed care of themselves and their families, including people diagnosed with chronic conditions. Through its Community Rewards program even the healthiest Members receive benefits from simple yearly check-ups, and Members with chronic and life-threatening conditions are eligible for early-intervention and population health management services.

"We want our Members to receive the right care at the right time from the right care providers," says Dr. Karen Hill, Medical Director and Senior Vice President, Community Health Choice. "For some people this means a phone call to our Nurse Help Line or virtual physician service, while for others the right care may be a clinic or even emergency services. People with chronic conditions may need more frequent interventions to stay healthy, and that's where care management really can make a difference."

Community's managed care approach combines in-house and third-party programs. Community Rewards and the Life Services team connect Members directly with benefits and training, while relationships with specialty health vendors create health management teams for eligible Members with chronic conditions.

"Some Members qualify for house calls from providers," says Hill. "Many people think house calls are a thing of the past, but targeted in-home visits are part of our approach to help Members with chronic conditions achieve better health results with lower costs and a better patient experience overall."

Community's collaboration with PopHealthCare identifies Marketplace Members with a variety of chronic conditions who are at risk for worsening health. "Our team fills crucial gaps between primary care visits and helps patients better understand and manage their own care," says Dr. Melinda Henderson, Chief Medical Officer at PopHealthCare. "We perform in-home assessments, identify treatment plans, and are available around the clock to help patients with the decisions and care that help them stay healthier."

Community Marketplace Members enrolled in a PopHealthCare cohort have been able to request workplace meetings as well as in-home care and are learning how to navigate when and how to seek emergency care. "One of our Community patients received an early diabetes diagnosis and asked his PopHealthCare team to meet with him at work during his lunch break," says Henderson. "He was able to stay on the job while receiving customized care and advice about his health choices. Another Community patient was able to avoid an emergency room trip by first talking on the phone with her care team and then scheduling a quick in-home follow-up visit."

While Community's collaboration with PopHealthCare covers multiple chronic conditions, Community has launched a diabetes-specific program with NovuHealth, a leading member engagement firm, for eligible Marketplace health plan Members. "Diabetes is on the rise in urban areas including Houston," says Hill. "Since diabetes can be controlled and even reversed, Member involvement in their own care is crucial."

NovuHealth partnered with Community to implement rewards and incentives to increase member activation and completion of diabetic health care activities that fit well with Community's existing Care Management Program. "We motivate Members to complete high-value activities that improve their health," says Eileen Cianciolo, NovuHealth Chief Product Officer, "which helps organizations like Community Health Choice meet their goals of better Member health with lower costs."

"We saw successful outcomes from our NovuHealth collaboration from the very beginning," says Pam Hellstrom, Community's Chief Compliance and Quality Officer. "We have been able to reach more Members at risk from diabetes who have responded very positively and have stayed engaged in their own health care and outcomes."

Community continues to serve its Members with innovative partnerships and programs, ranging from carefully targeted interventions like PopHealthCare and NovuHealth, to broader opportunities like virtual physician services. "All Marketplace Members are invited to sign up with Teladoc Health as part of their health insurance plan benefits," says Community's Dr. Hill. "Once enrolled, Members can call the toll-free number and talk with a physician to determine a next step. While sometimes the right care is in your doctor's office or even at a hospital, often what Members need is a different kind of access to care, consultation and treatment."

Community Rewards, Life Services, virtual physicians, and targeted population health care teams are some of the ways Community seeks to improve the health and wellbeing of adults and children. Community Health Choice (CommunityHealthChoice.org) serves more than 400,000 Members in 20 counties in Texas, through Marketplace, Medicaid, CHIP, and group health plans.