The Value of Collaboration, Illustrated by One Couple’s Story

Posted by: Mark Wendling, MD
Date: November 17, 2016

It is interesting to reflect on how far Lehigh Valley Health Network (LVHN) providers have come on the journey to value-based care. I have been a family physician at LVHN since 1997 and I now have more patient information at my fingertips than ever before so that I am able to provide the right care at the right time and place. You may be seeing a great deal of news headlines lately highlighting stories of health networks and insurers working together. By partnering with insurers like Highmark, and combining their insurance data with the medical data we already have, even more care coordination is possible. Let me provide you with an example.

Patients Mr. and Ms. Jones (not their real names) had multiple health problems when they sought my care. Ms. Jones, only 48 years old, had a major heart attack, and while still in the open heart unit, suffered a massive stroke. Meanwhile, Mr. Jones, who was the caregiver for his wife, had heart disease and unfortunately ended up in the hospital the same time she did.

At the time of discharge, Mr. and Ms. Jones’ medications were reviewed with their insurer, whereby a frightening discovery was made. The medications on record with the insurer were different than what was documented on their medical charts, which were also different from what I had recorded. I suggested the couple bring all of their medications into the office so we could review them together. Upon investigation, I discovered that they were taking multiples, some of the same drug classifications. As you can imagine, this could be harmful, if not potentially deadly.

Mr. Jones also mentioned that he couldn’t see the writing on his pill bottles clearly. I reviewed when he had last received an eye exam, and noticed that he was long overdue. My team immediately made him an appointment with a retinal specialist who discovered severe bleeding at the rear of his eye. This was likely caused by the duplicative blood thinners he was taking. The specialist was able to stop the blood thinner and treat his eye, saving Mr. Jones from even further serious conditions such as muscle breakdown or liver failure.

So, what does this all mean? In the past, providers only had patient information that was gained through medical records. Now, by partnering with insurers, physicians and their clinical teams have access to insurance claims data. By means of innovative partnerships with population health management companies that have the ability to merge the medical and insurance data and turn it into actionable information, clinicians have a wealth of information that provides a complete view of a patient’s health.

“You have to get to know people, really know them, and that takes time,” says Dr. Wendling. “By utilizing population health analytics, where the aforementioned data is sliced and diced in meaningful ways, duplicative services and care gaps are identified almost automatically. This allows me to have more meaningful conversations with my patients during visits whereby I can really get to the core of their health care needs.”

In the case of Mr. and Mrs. Jones, their lives could have ended up very different had Mr. Jones issues not been caught, affecting not only him, but also his wife who depends on him for her care.

Dr. Wendling is Executive Director at Lehigh Valley Physician Hospital Organization(LVPHO)/Valley Preferred, and guest author to the eNews