Health equity in motion with Audrey Sefakis
Through conversations with Point32Health colleagues, our Health Equity in Motion series shines a light on health inequities happening within our communities and across the United States, as well as ways that we’re aiming to advance health equity for our members.
An estimated 129 million Americans have at least one chronic disease according to the Centers for Disease Control. And as five of the top 10 leading causes of death are from preventable or treatable chronic diseases, it’s evident that there are barriers in place for those who may need support.
To understand how our organization is helping members with chronic conditions and other health needs, we spoke with Audrey Sefakis, vice president of care management programs for our commercial and Medicare Advantage member populations.
Q: At Point32Health, you currently work as the vice president of care management programs for commercial and Medicare. Could you please share more about the teams you oversee?
Audrey Sefakis: As the vice president for commercial and Medicare Advantage care management (CM), I oversee the clinical programs that support our members in those areas. I also oversee our clinical strategy and specialty programs, which include our nurse practitioner program, pharmacy CM, training team and dementia care consultants. All these functions support our integrated care delivery model designed to improve the management of complex physical, psychological and social areas of health with cost-effective strategies that support better quality, improved outcomes and member satisfaction.
Our care management teams work with our members to provide specific support based on each member’s needs. We are embedded in the communities that Point32Health serves and collaborate closely with physicians to provide needed resources for our population.
Q: How do your teams help to support members with chronic conditions? And why is it important for a health plan to offer this kind of support?
AS: Our teams consist of registered nurse care managers, behavioral health care managers, community health workers, care coordinators and pharmacy clinicians who work together to support the members with the goal of self-managing their conditions through member-specific plans of care. We provide support, education, medication reconciliation and navigation within the complex healthcare system. We have programs to support chronic conditions with disease-specific assessments and clinical pathways. We work collaboratively with our internal departments (utilization management, member services, provider partnerships) and external partners (visiting nurse agencies, community agencies, etc.) to ensure seamless referral processes and collaborative member support. We receive referrals from members, caregivers and internal departments, and support members during times of transition through inpatient facility notifications. We aim to assist members once they return home to enable success and reduce re-admission and emergency room visits.
It is important that we, as a health insurer, have a population health strategy with a goal to identify members early, help close gaps in care, and ultimately deter the potential for rising costs with chronic conditions.
Q: What are some of the biggest barriers people face when it comes to accessing health care?
AS: Health care is very complex, and understanding health plan benefits and available resources is challenging. There are also gaps and inequities in health care, and members may have a hard time understanding the information given to them by providers.
One way we aim to help with that is through our community health workers (CHW). The CHW team works with members who have access issues related to transportation and can provide education with tools in multiple languages. They can also focus on food insecurity and other social issues that may pose barriers to receiving good healthcare. For commercial and Medicare Advantage members, most of these things are not a covered benefit, and need to be paid for out of pocket. Our CHWs can work on financial planning to assist with spending down assets or looking at programs that may be available to members in their community.
Q: Are there any related resources, programs or services available to members that you want to share more about?
AS: A number of CM services we offer to our members remain relatively unknown and are a free benefit. Some of those offerings include:
- The CHWs have a Social Determinants of Health fund that can be utilized to provide healthy foods to our members.
- Our pharmacy team can work with members on available drug rebates as well to help offset drug co-payments and costs.
- The interdisciplinary team provides a comprehensive approach to navigating health care to support our members.
- The Dementia Care Consultant program works in tandem with the Alzheimer’s Association to provide caregiver support to those with cognition issues.
We also partner with other agencies and refer members for additional, external resources, like the American Heart Association, American Diabetes Association and American Lung Association, to name a few. There are community resources such as food pantries, churches, senior centers, community agencies, visiting nurse services and hospice agencies that we also recommend to our members.
For more information on the care management services we offer are part of our health plans, choose one of the options below:
Harvard Pilgrim Health Care Tufts Health Plan, Medicare Advantage