The Health Plan goes the extra mile in helping members manage chronic conditions.


Jim Pennington,
The Health Plan president and CEO.

If you’ve lived in West Virginia for a while, you’ve probably noticed a bright green apple on a billboard, in your doctor’s office, or even on your insurance card. The Health Plan’s apple logo has long been a symbol of good health and well-being, and the employees who work there help carry out that mission every day.

For 40 years, The Health Plan (THP), has been committed to improving the quality of health care throughout the state, providing neighbor-to-neighbor customer service, and continually growing through innovation. As a nonprofit health organization, 90 cents of every dollar goes toward the care of its members. This allows members to receive health care management with a personal touch—which, in turn, is helping West Virginians overcome some of the state’s biggest health crises.

One-on-One Support
West Virginians have long struggled with chronic conditions such as diabetes, heart disease, and chronic obstructive pulmonary disease (COPD). In fact, West Virginia ranks first in the nation in the prevalence of heart disease and COPD and second in the incidence of diabetes.

When it comes to improving health outcomes across the state, preventive care and education are imperative. West Virginians need advocates to make navigating the healthcare system easier—and that’s where THP comes in.

THP has made tackling these chronic health conditions a priority through their disease management programs. THP’s registered nurses act as care navigators, helping to create simple and effective care plans with members and their doctors. Members who have been diagnosed with diabetes, COPD, chronic heart failure, or coronary artery disease are paired with registered nurses who give them the information and tools they need to take control of their health.

More than 1,300 members are currently engaged in one of THP’s disease management programs. The one-on-one support provided by these programs helps build trust among the entire care team while treating members with the empathy, dignity, and respect they deserve.

Taking on the Opioid Crisis
In addition to struggling with chronic disease, West Virginia is also in the grip of the ongoing opioid crisis. Lawmakers, governmental organizations, and private and public entities have pushed to come up with solutions to ease the hardships West Virginians are facing. While there are no quick fixes to solve this complex problem, THP is part of a collaborative effort to figure out how to move toward progress.

In 2018, the West Virginia Department of Health and Human Resources implemented an Opioid Response Plan, outlining a multifaceted approach to addressing the opioid crisis including prevention, early intervention, treatment, overdose reversal, and social support. These first steps are vital to improving rates of addiction, prescription drug misuse, and recovery.

To help address these issues, THP worked to become part of the solution. In fall 2017, THP implemented an opioid management program to minimize the risks of addiction. Through this program, members who receive their first opioid prescription are limited to a five-day supply of medication. During that time, members receive individualized education from certified behavioral health staff regarding safe use of opioids and the risks associated with misuse.

THP also implemented a drug dependency treatment program for those already struggling with addiction, which includes both pharmacotherapy and behavioral health therapy. Since this program was initiated, THP has successfully helped guide more than 2,000 members toward lives of recovery.


Working Together
Recognizing the strength in numbers, THP has also embraced strategic partnerships that align with its values and goals. For more than a decade, THP has partnered with Camp Catch Your Breath and Camp Kno Koma to provide resources to the community that address significant health concerns for West Virginia’s children.

The two summer camps, focused on children with asthma and diabetes respectively, provide education in a fun, safe setting where the kids can learn to live well with their conditions. Qualifying THP members can attend these camps free of charge. In 2018, THP received applications from 24 children who wanted to attend Camp Catch Your Breath, the highest number since the company began offering grants in 2008.

Initiatives such as these, along with support from disease management nurses, has increased medication compliance and helped lower emergency department visit rates among engaged members.

THP sees it as their responsibility to help build stronger, healthier communities, which is why the company has made some crucial investments that benefit the entire state. Most noteworthy is THP’s scholarship program, which has now been around for more than 10 years. During that time, THP has awarded over $2 million dollars in tuition to 46 doctors and nurses who are proud to call West Virginia home.

This not only keeps West Virginia’s best and brightest medical talent in the state but also provides patients with access to health care providers who can empathize with their struggles and better understand their care needs and potential barriers.

A Hometown Advantage
Coming off of an exciting year in their new corporate headquarters in Wheeling, THP is showing no signs of slowing down. As the state’s only West Virginia–based non-profit managed care organization, the company has goals that include becoming West Virginia’s insurance provider for foster care and continuing to create a quality of care model among health systems across the state.

So what sets THP apart from the rest? Ask James Pennington, president and CEO of The Health Plan, and he’ll say it’s all about the people. “One of our biggest strengths as a company is the dynamic team of health care professionals that we have working today, day in and day out, to make sure our members are taken care of,” he says. “By having experienced doctors, nurses, pharmacists, and behavioral health specialists in-house, we are able to easily collaborate and deliver innovative and effective solutions to help our members.

“We also place an emphasis on treating our members how they would want to be treated. With nearly all of our employees born and raised in the area, we have unique insight into the barriers our members face as well as the resources that are available to help them.”

Addiction, or substance use disorder, is a chronic disease. Like many chronic conditions, it is no respecter of persons—striking people of all ages, genders, races, ethnicities, and socioeconomic backgrounds. And like some chronic diseases, such as diabetes, choices are involved in the development and perpetuation of the disease. It is important to note, however, that this condition is amenable to treatment and not a moral failing.

WVU Medicine experts are working diligently to turn the tide of the opioid epidemic and the stigma surrounding it by treating those already in the throes of addiction, advocating to lawmakers on their behalf, finding new opioid-free ways to treat chronic pain, and researching ways technology could be used to prevent relapses in those who are in recovery.

About The Health Plan
The Health Plan offers a wide variety of insurance products, including commercial, self-funded, Medicare, Medicaid, and PEIA plans, and is also the only plan in West Virginia that provides a plan for dual-eligible Medicare and Medicaid patients. THP’s Dual-Eligible Special Needs Plan serves West Virginia’s most vulnerable population, many of whom are disabled, diagnosed with multiple chronic illnesses, and living on very limited incomes.

 

Emma’s Story
Emma*, a teenage Medicaid member with THP, is an example of how proper intervention can create lasting, positive changes in health outcomes and quality of life.

Emma was experiencing serious complications as a result of uncontrolled diabetes. She was enrolled in THP’s case management program, where she had the support of a complex case manager as well as a certified diabetes nurse educator. Once it became evident that her parents weren’t able to provide the level of care needed to maintain her health, Emma’s care was transferred to her grandmother. Her THP case manager helped Emma’s grandmother receive full custody and worked hand-in-hand with both grandmother and granddaughter to make sure they had the information, tools, and resources needed to take control of Emma’s health.

Emma now regularly attends school and her A1C (blood sugar) levels are much healthier. She is eating home-cooked meals and keeping up with routine doctor’s appointments. Emma has also experienced a tremendous improvement to her emotional well-being. Her grandmother tells us she is “blossoming,” making friends at school and feeling a sense of comfort and care at home.

*Name and other identifying information have been changed for privacy protection.

 

written by Alex Panas-Moore