Collaborating with Doctors

Collaboration, mutual respect and communication are at the heart of relationships with doctors.

We view doctors as equal partners in keeping our members healthy.

Universal American collaborates with our members' primary care doctors, and we have case managers who work hand-in-hand with the members' doctors, analyzing claims and utilization data to alert doctors of any potential gaps in care.

We achieve better health outcomes for our patients through strong professional partnerships, clinically sound benefit designs, total care management, quality outcome measurements, and health policy advocacy.

A Model of Collaboration

Our TexanPlus^® HMO Medicare Advantage Plans give our network doctors the support they need to establish medical homes for our members. In a medical home, a primary care physician coordinates all testing and specialist visits, access to various therapy services, acute care services and a long list of social support services to treat the needs of the whole patient. Working in tandem with our case managers, we believe this model leads to better health outcomes for our members.

For example, our Registered Nurse Care Managers can review claims data and alert our physicians when members are due for testing or office visits. Physicians then call our members to schedule an appointment. If necessary, our care coordinators can arrange for transportation to take our members to and from the doctor’s office visit. We also follow up with our members to make sure they have the supplies, medications and medical equipment they need.

As a result, for our TexanPlus members with diabetes, we’ve seen a 24% increase in doctor visits; a 64% increase in outpatient hospital visits; an 11% decrease in inpatient admissions; and a 16% decrease in inpatient days compared to similar patients in Traditional Medicare*.

In our coordinated care plans, we give our doctors the freedom to establish patient-centered medical homes for our members, in which doctors orchestrate their care.

*According to an upcoming research paper by AHIP's Center for Policy and Research.