Dataset Information

Experience with health coach-mediated physician referral in an employed insured population.

ABSTRACT:

Background

Given increasing interest in helping consumers choose high-performing (higher quality, lower cost) physicians, one approach chosen by several large employers is to provide assistance in the form of a telephonic "health coach" - a registered nurse who assists with identifying appropriate and available providers.

Objective

To evaluate the health coach's influence on provider choice and the quality of the user experience in the early introduction of this service.

Design

Cross-sectional survey of 3490 employees and covered dependents of a large national firm that offered health coach services to all employees and covered dependents. The survey began in September 2007 with proportionate stratified sampling of 1750 employees and covered dependents who used the services between October 2007 and February 2008, and 1740 non-users.

Participants

Insured adults (ages 21-64) employed by a large national firm or covered dependents of employees.

Measurements

Awareness of the service, reason for using service, visits to providers recommended by service, use of health advice provided by service, user satisfaction.

Main results

The primary reason for using the service was to obtain provider referrals (73%). Fifty-two percent of users sought a specialist referral, 33% a PCP referral and 9% a hospital referral. Eighty-nine percent of users seeking a provider referral were referred in-network; 81% of those referred visited the referred provider. Measures of satisfaction with both the service and the care delivered by recommended providers were over 70%.

Conclusions

Customers largely follow the provider recommendation of the health coach. Users express general satisfaction with existing health coach services, but differences in performance between vendors highlight the need for the services to be well implemented.

SUBMITTER: Donelan K

PROVIDER: S-EPMC2955479 | biostudies-literature | 2010 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Experience with health coach-mediated physician referral in an employed insured population.

Donelan Karen K Rao Sowmya R SR Rogers Robert S RS Mailhot Johanna R JR Galvin Robert R

Journal of general internal medicine 20100616 10

<h4>Background</h4>Given increasing interest in helping consumers choose high-performing (higher quality, lower cost) physicians, one approach chosen by several large employers is to provide assistance in the form of a telephonic "health coach" - a registered nurse who assists with identifying appropriate and available providers.<h4>Objective</h4>To evaluate the health coach's influence on provider choice and the quality of the user experience in the early introduction of this service.<h4>Design ...[more]

PMID: 20556533

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Project description:ObjectiveTo describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors.Data sources/study settingSecondary data collected from The University of Texas System, which self-insures approximately 6,000 physicians at six health campuses across the state. We obtained internal case management data for all medical malpractice claims closed during 1 year before and 6 recent years following the enactment of state tort reform legislation.Study designWe retrospectively reviewed information about malpractice claimants, malpractice claims, and the process and outcome of dispute resolution.Data collection/extraction methodsWe accessed an internal case management database, supplemented by both electronic and paper records compiled by the university's Office of General Counsel.Principal findingsClosed claims dropped from 244 in 2001-2002 to an annual mean of 96 in 2009-2015, closures following lawsuits from 136 in 2001-2002 to an annual mean of 28 in 2009-2015, and paid claims from 60 in 2001 to an annual mean of 20 in 2009-2015. Patterns of resolution suggest efforts by the university to provide some compensation to injured patients in cases that were no longer economically viable for plaintiffs' lawyers to litigate. The percentage of payments relating to cases in which lawsuits had been filed decreased from 82 percent in 2001-2002 to 47 percent in 2009-2012 and again to 29 percent in 2012-2015, although most paid claimants were represented by attorneys. Unrepresented patients received payment in 13 cases closed in 2009-2012 (22 percent of payments; mean amount $60,566) and in 24 cases closed in 2012-2015 (41 percent of payments; mean amount $109,410). Even after tort reform, however, claims that resulted in payment remained slow to resolve, which was worsened for claimants subject to Medicare secondary payer rules. Strict confidentiality became a more common condition of settlement, although restrictions were subsequently relaxed in order to further transparency and improve patient safety.ConclusionsMalpractice litigation risk diminished substantially for a public university health system in Texas following legal changes that reduced rights to sue and available damages. Health systems operating in a low-tort environment should work with policy makers, plaintiffs' attorneys, and patient groups to assist unrepresented patients, facilitate early mediation, limit nondisclosure obligations following settlement, and expedite the resolution of Medicare liens.

Dataset Information

Experience with health coach-mediated physician referral in an employed insured population.

Background

Objective

Design

Participants

Measurements

Main results

Conclusions

Publications

Experience with health coach-mediated physician referral in an employed insured population.

Similar Datasets

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