Why care coordination matters for Medicare members

Patrice King Brown: Whether you’re new to Medicare, exploring your options, or just want to keep up with the latest in Medicare news, we’ve got you covered.

Stacy Smith: No fluff, no jargon. Just real conversations to help you navigate Medicare with confidence. I’m Stacy Smith.

Patrice King Brown: And I’m Patrice King Brown. Welcome to “Medicare for the Record,” brought to you by UPMC for Life.

Stacy Smith: Welcome to another episode of “Medicare for the Record.” Patrice, we've gone over a lot of material, but there's still a lot more to go over.

Patrice King Brown: You're absolutely right, Stacy. There's a lot to cover. Today's healthcare system can be complicated, especially for Medicare beneficiaries who see multiple doctors or take several medications or manage chronic conditions. One of the most important parts of a positive healthcare experience is making sure that all the pieces fit together. That's where care coordination comes in. In this episode, we'll discuss how care coordination helps improve the patient experience, why your primary care provider serves as the quarterback of your health team, and how a coordinated approach can help you stay healthier and avoid unnecessary complications.

Stacy Smith: And with us to talk about this is Dr. Dillon Stein. He's the assistant vice president of Medicare Medical Services at UPMC Health Plan. Doctor, thanks so much for being with us. Give us a little bit about your background.

Dr. Dillon Stein: First and foremost, I'm from Pittsburgh, so southwestern [Pennsylvania] born and bred. Did internal medicine training as my primary board, and then moved on to be specialized in hospice and palliative care at UPMC. Actually, stole away from the city to treat underserved and rural populations in palliative care for about 10 years before returning back to UPMC now as AVP of Medicare Medical Services.

Patrice King Brown: Dr. Stein, we mentioned coordinated care. Can you explain more about that? What is that?

Dr. Dillon Stein: Well, it's really what it sounds like. The coordination of care in a very complex environment, right? Healthcare in itself is a complex environment. And so having coordinated efforts that occur between physicians, hospitals, pharmacists, nursing, even your health plan—coordinating care amongst all those different levels around a diagnosis or taking care of people really helps make things more efficient. It helps simplify plans—and hopefully at the end of the day, really makes it really good quality care for the members.

Patrice King Brown: So why do you think it's so important for Medicare beneficiaries, especially?

Dr. Dillon Stein: This may or may not be a secret: As we age, we’re more likely to develop diagnoses, medical problems ranging from hypertension or high blood pressure or heart disease. And as those things come together and stack on top of one another, you can imagine that things can become more complex. So coordinating care around individuals who have serious illness, who have these diagnoses, especially in Medicare as we age, it becomes increasingly important that we are managing it in a coordinated fashion to make sure, again, to bring that good quality care.

Stacy Smith: People have sometimes referred to the primary care provider as a quarterback. What does that mean when we're talking about coordinated care?

Dr. Dillon Stein: So when we think about a quarterback in the field, the primary care physician, primary care provider, PCP—they are truly the quarterbacks of your healthcare team. And they do that by helping you navigate and make sure you got the right play call. So by assisting with things like preventative services, assisting with routine screenings, assisting with chronic care management, a lot of those things can pivot around having a really great primary care provider to ensure that you're getting to the right specialist, you're having the right tests, and ensuring that you're getting the best care possible.

Patrice King Brown: So how do Medicare Advantage plans kind of support this coordinated care?

Dr. Dillon Stein: Medicare Advantage plans like UPMC for Life do it in many different ways. The biggest way is probably partnering with networks. So that means hospitals and physicians to ensure that you have access to care, so you have the people that you need to see. You have your primary care doctor, you have your specialist—but also provides other benefits that maybe we don't sometimes think about. There are options for helping with things like pharmacy, so making sure that you have the right medications and checking in on those. There are services coming into the home to evaluate things like home safety and falls prevention. There's really a lot of things that can be done within Medicare Advantage plans that provide a lot of benefit that at the end of the day, help people age where they want to age, but also in the best way possible.

Patrice King Brown: Yeah. You think about aging gracefully or aging in place. Aging at home is how most people want to do it.

Stacy Smith: Doctor, what about the costs? Can coordinated care help to lower the healthcare costs?

Dr. Dillon Stein: It comes down to efficiency and ensuring quality. When we think of quality, part of it's cost, but really a lot of it's outcomes. So how well is someone doing at the end of the day? And to provide the best quality for someone, it is about making sure that you're taking the next best step for them. So by coordinating care, by ensuring that they're taking the next best step in their medical care, in their prescriptions, in their care management, whatever we want to say, that next step becomes really important. And the better we coordinate those things, the more efficient they become. And there's less waste, right? For example, if you go to your primary care doctor and you get blood work done, you don't want to go to your cardiologist then the next day or a surgeon or anybody and have the same work done.

So by coordinating things together in a network and utilizing the health plan benefits as well, we really help facilitate an understanding of what's happened so we can make sure we just keep moving down the road.

Stacy Smith: Doctor, how effective is this coordinated care? Is it working?

Dr. Dillon Stein: Yeah, it certainly is working. It's being done really in every Medicare Advantage plan, including UPMC for Life. It's ensuring that people are getting the right care at the right time, the right place. Once again, the best quality that someone can get out of their healthcare.

Stacy Smith: So the physician, your personal care provider, is speaking and talking with the other providers that you might have, whether it be a cardiologist or an [orthopedist] or something?

Dr. Dillon Stein: Yes. And the way that that happens—I'll say nowadays, because it was actually, I was practicing at one point where it wasn't—there's communication happening all the time. And sometimes it's by phone. Sometimes it's by letter still, but also it comes down to EMR, right? Electronic medical records. So that communication's happening a lot. And having a good network of hospitals and providers that utilize those types of records—instantaneous communication, which really is really helpful.

Patrice King Brown: What about preventative care? I know it makes sense that we would do our best to prevent it, but it's not always possible to prevent an issue. So how does this come into play for our healthcare?

Dr. Dillon Stein: Preventative care is an essential part of how we take care of ourselves, and in healthcare, how we help take care of others. Because if you are able to identify people at risk of developing some sort of illness or developing some sort of medical issue down the road, when they say an ounce of prevention is—

Patrice King Brown: A pound of cure.

Dr. Dillon Stein: Pound of cure, right? So if we're being preventative about how we maintain our health and we go to screenings and those sorts of things, we can reduce the risk of us developing something—I say “us” as people—reduce the risk of developing some sort of serious diagnosis that if left untreated or left unmanaged can really cause a lot of problems. So like anything else, prevention's always the best measure. Maintaining access to that is also first and foremost, which is again, your primary care doctors are great people to be going to in order to make sure that you're staying up to date on your preventative services.

Stacy Smith: What if someone has a chronic condition? Are they more supported by something like this?

Dr. Dillon Stein: Absolutely. That open communication and dialogue between a health plan and a provider really helps manage some of those chronic conditions that can lead to downstream complications. So that's heart disease and COPD. What coordinated care can do is it can actually facilitate ways of getting people involved with programs that can help with pharmacy and pharmacists. Really help align individuals with the appropriate treatment plan by using the benefits that we have in the Medicare Advantage plans. All in hopes of reducing complications for people.

Stacy Smith: A moment ago I asked you about how things were going as far as coordinated care goes, and I was looking at the medical side of it. But what can people do themselves on becoming more active in their care?

Dr. Dillon Stein: I'm a big believer in advocacy. I think advocating for yourself, advocating for your loved ones, is where it should start. The benefits are there. As Medicare Advantage members, sometimes we don't know they're available. So advocating for yourself, asking questions, developing that relationship with your primary care doctor and making sure—and this is my palliative care background coming out, is aligning with what's important to you. Ensuring that your voice is being heard along the way, there's nothing more important to that because it's your health journey. It's not mine. It's not your primary care doctor's. It's yours. And so taking that opportunity to take that power back I think is really important.

Patrice King Brown: Dr. Stein, we appreciate your expertise. It’s very good information.

And we have a few things for you to take away from our conversation today. A strong relationship with your PCP can be beneficial for your long-term health. Preventive care helps identify potential health concerns early so that you can address issues sooner and stay healthier over time.

Stacy Smith: And coordination between your doctors and your health plan is important, but you also play an important role when you stay active and engaged in your healthcare. For more information, you can visit medicare.gov, cms.gov, or the UPMC for Life website, which is upmchealthplan.com/medicare.

Patrice King Brown: Thank you so much for joining us today, Dr. Stein. And we hope you will join us for our next episode for “Medicare for the Record.”

Thanks for tuning in to “Medicare for the Record,” brought to you by UPMC for Life. To learn more about your Medicare options, visit upmchealthplan.com/fortherecord.

This podcast is provided for general informational and educational purposes only. It is not medical care or advice. For questions regarding medical care, please consult with your healthcare provider. Views and opinions expressed by the participants are solely their own and do not necessarily reflect those of UPMC Health Plan, its subsidiaries, parents, or affiliates.