{"id":140225,"date":"2025-02-10T18:27:29","date_gmt":"2025-02-10T23:27:29","guid":{"rendered":"https:\/\/www.thevalleyledger.com\/?p=140225"},"modified":"2025-02-10T18:27:29","modified_gmt":"2025-02-10T23:27:29","slug":"upmc-capital-blue-cross-a-conversation-about-affordability-accessibility-and-quality","status":"publish","type":"post","link":"https:\/\/www.thevalleyledger.com\/?p=140225","title":{"rendered":"UPMC & Capital Blue Cross: A conversation about affordability, accessibility, and quality"},"content":{"rendered":"

By Capital Blue Cross \u2013 \u00a0THINK<\/a><\/em>\u00a0(Trusted Health Information, News, and Knowledge) is a community publication of Capital Blue Cross. Our mission is to provide education, resources, and news on the latest health and insurance issues.<\/strong><\/p>\n

What challenges do healthcare systems face in 2025 and how can they work with insurance carriers to deliver affordable, accessible, and high-quality care?<\/p>\n

Enhancing access to quality healthcare with a focus on affordability isn\u2019t a solo endeavor. Even for an organization as large as UPMC, partnerships \u2013 especially those with insurance carriers \u2013 are vital to ensuring patients have access to the best outcomes at a reasonable cost.<\/p>\n

David Gibbons<\/strong>, Senior Vice President of UPMC\u2019s Health Services Division and Regional President of UPMC in Central Pa., recently discussed how evolving partnerships with insurers like Capital Blue Cross can impact healthcare access and quality throughout Central Pennsylvania.<\/p>\n

Gibbons sat down with\u00a0Capital Blue Cross<\/strong><\/a>\u00a0for a discussion about some of the challenges facing healthcare systems and what they need to deliver affordable, accessible, and high-quality care.<\/p>\n

Capital<\/strong>: We are navigating a new, post-COVID world and have experienced so many changes across the healthcare landscape. As a healthcare leader, what are the top issues systems like UPMC are focused on and what role can insurers like Capital play to help?<\/span><\/p>\n

\"\"<\/a>
David Gibbons, UPMC<\/figcaption><\/figure>\n

Gibbons<\/strong>: You\u2019re right, a lot has changed since the COVID pandemic, which has caused us to prioritize several key issues. For starters, data. We have plenty of data that can help us make smart, informed decisions that help us better evaluate costs and the effectiveness of care across hospitals and specialists within the UPMC system. This helps us balance innovation to focus on best practices, then establish benchmarks we can set to determine how to reduce costs.<\/p>\n

That\u2019s where our partnerships, especially with insurers like Capital, are so important. They play such a vital role in helping to ensure the unique needs of each patient can be met, especially for those who have complex cases that require regular and frequent communications, appointments, and follow-up care. Having an efficient feedback loop in place that connects us to the insurer and to patients and their caregivers can help curb future costs while ensuring better health outcomes for patients.<\/p>\n

Think about patients who are battling cancer or a rare disease. Sharing data is important, but there\u2019s so much more to the story that we can impact by driving connections. What additional resources are available and how can they be more easily accessed? How can we better coordinate care to reduce duplication and errors? What else can we learn about the patient\u2019s situation? This is where insurers like Capital can really help provide big picture clarity across the care continuum.<\/p>\n

Capital<\/strong>: One thing we all learned during and after the pandemic was the value telemedicine services can bring to the market. What has the rapid evolution of telemedicine meant to UPMC and what does it mean to the future of care delivery?<\/span><\/p>\n

Gibbons<\/strong>: One of the big things the pandemic taught us was to look at accessibility differently. It\u2019s a challenge. So many healthcare systems across the country are facing staffing issues, so partnering with insurers on alternative treatment options, like telemedicine, can go a long way to ensuring adequate access to care. In fact, UPMC has seen a 16% increase in the use of telemedicine from last year to this year and a 66% increase in online scheduling.<\/p>\n

For some of our doctors and other providers, there are days that they do nothing but telehealth appointments for patients who were discharged from the hospital. This helps us identify patients who are at high risk, then we can schedule follow-up calls with them to make sure we\u2019re meeting their needs.<\/p>\n

It\u2019s not just about the impact to our system, though. Think about it from the perspective of a patient. The efficiency. The convenience. The time saved. The money saved. The shortened wait times and streamlined follow-up. All of it has made for smarter ways we can enhance access to care without sacrificing quality, all while improving the patient experience.<\/p>\n

Capital<\/strong>: Telemedicine could only happen because of advancements in technology, which evolves at such a rapid pace. How else is UPMC harnessing the power of technology to enhance healthcare resources and improve patient care?<\/span><\/p>\n

Gibbons<\/strong>: It feels like anytime we talk about technology these days, artificial intelligence quickly comes to mind. We\u2019ve actually been using AI for a long time. We have a number of predictive models that use health records that, for example, factor variables like whether the patient lives alone, whether they have a flight of stairs, do they have a caregiver at home, how many medications do they take, what types of medications are they on, and so on. All of this data helps us develop predictive analytics that we can use to create personalized treatment plans designed to drive successful outcomes.<\/p>\n

AI has also helped us with other things like remote patient monitoring to help track health metrics and vital signs more closely. We\u2019ve found better ways to manage scheduling and staffing, which can help minimize wait times for patients when we\u2019re able to predict when services will be in higher demand. All in all, advancing the accessibility, efficiency, and quality of care through advanced technology is a priority.<\/p>\n

Capital<\/strong>: While telemedicine has helped enhance access to care, there are still many barriers that prevent many people from accessing adequate care. What other barriers to access are you seeing in our communities and what can we do together to address these issues?<\/span><\/p>\n

Gibbons<\/strong>: We\u2019re always looking for ways to expand and enhance care access. It\u2019s so important, especially in rural areas. And it\u2019s not just about being able to get to a doctor\u2019s office or hospital, or whether there\u2019s reliable internet service to connect with a patient. We\u2019re thinking bigger. Access to prescription drugs is a good example. We have to think more about things like does a local pharmacy have evening and weekend hours? When a doctor or nurse is writing a prescription for a particular medicine, does the local pharmacy carry it? These are things we might take for granted in urban and suburban areas, but there are many rural areas throughout our mutual footprint where these are real concerns.<\/p>\n

Aside from where someone lives, we need to look collectively at things like transportation, housing, finances, food security \u2014 the list goes on and on. How can we come together to remove these barriers? If we focus more on things like enhanced collaborative care coordination, advocating for policy changes, and improving health literacy, we can knock down these barriers.<\/p>\n

Capital<\/strong>: You just touched upon a few social determinants of health that can impact access to care. UPMC recently released a study about other factors associated with higher rates of prediabetes in adolescents, including food insecurity and low household income \u2013 two other social determinants that can have an adverse effect on someone\u2019s health. How can UPMC, Capital, and business leaders address nonmedical factors like these that impact health outcomes?<\/span><\/p>\n

Gibbons<\/strong>: There\u2019s a lot we can do collectively. We need to widen our perspective on who can help and expand our focus on what treatment looks like. We need to get creative. For instance, care can be so much more than offering medical or behavioral health services. It can also include support from social workers and care coordinators, who can help patients access resources like food assistance programs and financial counseling. I know Capital employs many social workers and care coordinators who are doing this important work.<\/p>\n

We can also team up with local food banks, housing authorities, and community centers to offer healthy food options. I have a really good example. Our hospital in York created a farm for a farm-to-table program where we\u2019ve shared 10,000 pounds of produce with patients, staff, and the community. It\u2019s helping to promote healthy eating, and again, it\u2019s the partnerships that help those types of efforts succeed.<\/p>\n

It\u2019s about looking through the community health needs assessment and identifying how we target those needs. Health systems, insurers, business decision makers, and community leaders all play an important role.<\/p>\n

Capital<\/strong>: Capital and UPMC have been at the forefront of building and maintaining strong value-based care models. How would you assess the state of value-based care and are those models really helping to drive change?<\/span><\/p>\n

Gibbons<\/strong>: Value-based care models absolutely do drive change. A key to value-based care is having measurable outcomes and working together to ensure those outcomes are met. That means everyone \u2013 insurers, doctors, health systems \u2013 has a vested interest in finding the most effective ways to increase quality of care and decrease costs of care.<\/p>\n

I would say that Central Pennsylvania is one of our most advanced markets for value-based care, and partnerships with insurers like Capital really fuel that success. A strong, collaborative relationship like ours leads to better results for healthcare consumers. An important part of value-based care is on the preventive side, making sure patients stay up to date on screenings and vaccinations, and promoting wellness.<\/p>\n

None of this works without a strong partnership. It’s not just about the contracted rates with Capital, it\u2019s about a commitment to quality, the outcomes, and the access. All three need to be there to make value-based care work.<\/p>\n

Capital<\/strong>: What are the biggest workforce challenges impacting health systems like UPMC and how does that impact your work to enhance access to care?<\/span><\/p>\n

Gibbons<\/strong>: Many healthcare workers across the country face burnout every day. So, we\u2019re looking for ways we can reduce stress and alleviate some of the burdens on our doctors, nurses, and other healthcare providers.<\/p>\n

A little thing we started doing was having therapy dogs come into the hospital for the healthcare workers. When you have five therapy dogs walking down the hall and you\u2019re working a medical shift, it really does lighten the mood.<\/p>\n

Another way to address our workforce challenges is by training our future workforce and creating a workforce pipeline to bring people into the healthcare profession. We are setting up schools of nursing, schools for radiation technologists, schools for medical assistants. The list goes on and on.<\/p>\n

A little over a year ago, we created our own nursing school by leveraging our UPMC school at Shadyside (in Pittsburgh) and partnering with UPMC Harrisburg and Harrisburg University. This August, our class had 200 students, and many are now our own employees.<\/p>\n

A third way we\u2019re addressing workforce challenges is by starting our own internal traveling employee program at UPMC. Rather than paying third-party companies for traveling nurses, for example, we pay our own employees to travel through the footprint of UPMC. It lowers our cost.<\/p>\n

We face many challenges, and we need innovative solutions to meet our future healthcare needs.<\/p>\n

 <\/p>\n

You can find more useful articles at\u00a0https:\/\/thinkcapitalbluecross.com\/<\/a><\/strong><\/p>\n

Information provided to TVL by:
\nJERRY REIMENSCHNEIDER
\nSenior Public Relations Specialist | Brand & Market Strategy
\nhttps:\/\/www.capbluecross.com\/<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

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