Health benefit for chronic illness now available to hospital and university employees
BY JOHN SANFORD
Ann Lindsay and Alan Glaseroff head the clinic aimed at better managing chronic conditions for university and hospital employees.
Employees at Stanford Hospital & Clinics and Lucile Packard Children’s Hospital are now eligible for an innovative new health-care benefit designed to make managing their chronic illnesses effective, easy and affordable.
The Stanford Coordinated Care Clinic is composed of physicians and other health-care providers who aim to help employees with chronic conditions — such as diabetes, depression, hypertension or asthma — lead healthy lives and get regular medical support.
Stanford University employees became eligible April 30 for the benefit, which is also available to early retirees and adult dependents covered by employees’ insurance. For more information on clinic eligibility and enrollment, visit http://stanfordhospital.org/coordinatedcare.
The goal of the clinic is to keep patients with chronic illnesses out of emergency rooms and intensive care units by better managing their conditions, said Alan Glaseroff, MD, the clinic’s director and a nationally recognized leader in providing innovative care to patients with chronic and complex diseases. Stanford and the hospitals are self-insured employers and hence bear the cost of such hospitalizations.
“The beauty of what we’re doing is that what’s good for the individual patient is good for the employer is good for the health-care system overall,” Glaseroff said. “It’s not often in medicine that you get to work in such a sweet spot.”
Patients with chronic illnesses often find themselves bouncing between specialists, who may not be communicating with one another and may not have a full picture of the patient’s health needs, said Glaseroff, who is also a clinical professor of medicine. Without the right knowledge and tools for managing their illnesses, patients often end up in the hospital. “Patients are the most important determinant of their own health outcomes,” he said. “If you look at what drives patient outcomes, their own behavior is at least four times as important as the care they receive.”
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The clinic, Glaseroff said, gives patients the tools and knowledge to manage their diseases, as well as a home base where they can receive intensive primary care, close monitoring of their medical regimens and support for their health goals from a range of experts, including nutritionists, behavioral coaches and physical therapists. The clinic also coordinates with specialists and other providers to make sure everyone involved in a patient’s care understands the patient’s needs and preferences.
“It can be hard to face a chronic condition alone,” said Ann Lindsay, MD, the clinic’s co-director and a clinical professor of medicine. “We will help patients take control of their life and health. Our team is here to help them with the medical, social and emotional aspects of trying to live in the healthiest way.”
Glaseroff estimated that of the roughly 36,000 employees and family members insured through the university, as well as through Stanford Hospital & Clinics and Lucile Packard Children’s Hospital, about 10 percent are struggling with some form of chronic illness. He cited one such patient who had been shuttled around to different specialists, but “each specialty was only looking narrowly at what could be going on with this patient.” What was missing was a more holistic view of her condition and a focus on how she defined improvement, he said.
“We worked with her to figure out what her goal really was, and we defined the goal as being able to walk,” he said. “So our team is working with her and interacting with specialists to achieve the goal of walking within a year.”
The notion of intensive primary care for chronically ill patients emerged from work begun several years ago by a team led by Arnold Milstein, MD, MPH, professor of and director of Stanford’s Clinical Excellence Research Center. The team dubbed this new form of care the “ambulatory intensive care unit” model, or A-ICU.
And while rigorous, time-intensive care often is considered the type of medicine only wealthy patients can afford, many self-insured employers are beginning to view it as a cost-effective approach; raising co-payments, sometimes in the name of “shared responsibility,” can discourage patients from taking steps to manage their chronic diseases and hence result in bigger expenses for employers down the line when those patients suddenly need acute care, Glaseroff said.
“We’re not saving anybody money by denying care, but we can save money by this kind of intensive ambulatory care,” he said. “And patients feel better and more in control of their lives.”
Today, the clinic only serves employees and their family members, but it will eventually expand its services to high-risk patients outside Stanford, Glaseroff said.
John Sanford is a writer in the communications office for Stanford Hospital & Clinics.
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