The UPMC Insurance Services Division carries out UPMC’s mission to serve communities by providing outstanding patient care and shaping the health system through technological innovation, research, and education. Our unique approach to health management touches UPMC Health Plan’s members, their families, and their communities.
Visit UPMC Center for High-Value Health Care to learn about other health research and implementation projects that improve outcomes for the most vulnerable populations.
The Birth Circle Doula Program
UPMC Health Plan was one of the first health insurers in the nation to provide coverage for “doulas” — women who offer nonmedical emotional and informational support to mothers before, during, and after childbirth. The Birth Circle doula program is available to members of UPMC for You. The program recruits and trains doulas to help mothers reduce risks for premature birth. In 2014, more than 460 expectant mothers used The Birth Circle. Of the babies born to these women, only four percent weighed under 5.5 pounds (compared to 9.5 percent city-wide), and only 23 percent were born by Caesarean section (compared to 40 percent city-wide).
The Connected Care™ program aims to strengthen the collaboration between physical and behavioral health care providers for members who have serious mental illness. In 2009, Connected Care was rolled out in Pennsylvania through a partnership of UPMC for You, Community Care Behavioral Health Organization, and the Allegheny County Department of Human Services, Office of Behavioral Health. During its first two years, Connected Care resulted in 12 percent fewer hospital readmissions among the targeted population. Data from the pilot led to improved communication and member access to resources. The program continues, and modifications are being evaluated to extend it to other populations with multiple chronic conditions.
Cultivating Health for Success
Homeless adults are five times more likely to be hospitalized than the general population, and two times more likely to be hospitalized than other low-income individuals. Research suggests that stable housing could improve health outcomes even more than additional doctor visits. Through Cultivating Health for Success, UPMC for You provides housing to 50 of its members who were identified as homeless. The program helps these members see their doctor, go shopping for essential items, find a permanent home, and keep it clean. Participants agree to use a specified UPMC primary care practice and receive case management support for physical and behavioral health conditions.
LifeSmart Diabetes Prevention Program
This program has been offered since 2008 through a partnership between Heritage Valley Health System (HVHS) and UPMC Health Plan. It provides free healthy lifestyle programs for HVHS patients who have been identified with risk factors for pre-diabetes or metabolic syndrome. Group lifestyle balance and individual nutrition counseling help them make healthy food choices, increase physical activity, and make positive lifestyle changes. Patients who are UPMC Health Plan members receive additional health education resources, like smoking cessation counseling. The program has been successful in delaying the onset of type 2 diabetes for the majority of its participants.
Read an article about this program which was published in the Beaver County Times.
Pregnancy Recovery Center at Magee Women’s Hospital of UPMC
UPMC Health Plan and Community Care Behavioral Health Organization teamed up to create a Pregnancy Recovery Center (PRC) at Magee Women’s Hospital of UPMC in 2014. PRC offers comprehensive care to drug-addicted pregnant women by providing medical support to prevent withdrawal during pregnancy, minimize fetal exposure to illicit substances, and engage the mother in her recovery. In its first year, PRC treated 73 women for addiction. Only 35 percent of infants born to those women required medication for withdrawal symptoms. By comparison, 73 percent of infants born to mothers who were treated for addiction at Magee in 2013 (prior to PRC) required medication for withdrawal. This early data indicates that involvement in the Pregnancy Recovery Center can lead to improved outcomes for mothers and their infants.
UPMC Community Treatment Team
Thousands of UPMC Health Plan members have complex medical, behavioral, and psychosocial needs that are difficult to manage with medical care alone. Many live in low-income communities that lack access to transportation, healthy food, and affordable housing. Such barriers make it difficult for them to obtain care, treat their conditions, and seek proper follow-up. The UPMC Community Treatment Team (CTT) was created by UPMC Health Plan and Community Care Behavioral Health Organization in response to this dilemma. It consists of nurses, case managers, community health workers, and pharmacists. When CTT was piloted with patients at UPMC McKeesport hospital from August 2014 through February 2015, it resulted in a 10 percent reduction of the hospital readmission rate among this population. This shows that patients are better able to manage their condition and are staying healthier, longer.