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
Not surprisingly, homelessness is a contributing factor to poor health outcomes. 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. With the Cultivating Health for Success program, UPMC for You works with community service partners through the Pennsylvania Department of Housing and Urban Development to provide stable housing and care management to eligible members who meet the criteria for homelessness. Cultivating Health for Success gives them an opportunity to have regular PCP visits for preventive care and resources to help them shop for essential items, find a permanent home, and keep it clean. Within the first five years of implementation, 85 percent of members enrolled in Cultivating Health for Success found stable housing. The program has resulted in keeping these members healthy for a longer period of time, and it has decreased the rate of costly hospital readmission and unplanned medical care among this population.
Cultivating Health for Success has been recognized as a best practice by leading organizations:
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 UPMC Magee-Womens Hospital
UPMC Health Plan and Community Care Behavioral Health Organization teamed up to create a Pregnancy Recovery Center (PRC) at UPMC Magee-Womens Hospital 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 (Community Care) in response to this dilemma. It consists of nurses, case managers, community health workers, and pharmacists. Members of UPMC Health Plan who were engaged by CTT showed a significant increase in their own assessment of their quality of life. They regularly complete a “medication reconciliation”—a review of medications that helps the member understand why they are taking their medications. These members are also more likely to see their primary care physicians after discharge. In 2017, the UPMC Center for High Value Healthcare received an award from the Patient Centered Outcomes Research Institute (PCORI) to evaluate what care management approaches by CTT will work best for these members.