CMS defines population health management as “a clinical perspective focused on delivering care to groups … and a broader perspective that focuses on the health of all people in a given geographic area (through) multi-sector approaches, and incorporation of nonclinical interventions to address social determinants of health.”
While this definition can initially seem cold and impersonal, companies like Medical Advantage are finding ways to blend high-level population health strategy with individualized care based on each patient’s unique circumstances. For one young woman, this progressive approach made all the difference – and changed her life dramatically thanks to a Medical Advantage care manager.
That young woman’s name is Janice, a 34-year-old who suffered from morbid obesity all her life – as well as mental health comorbidities due to the stigma and isolation of obesity. In January of 2018, Janice was referred to Jon Broek, a registered dietitian care manager at Medical Advantage. Janice’s medical history included morbid obesity with a weight of 650 lbs., bariatric surgery in 2014, and depression. After the bariatric surgery, Janice was overjoyed to lose 200 lbs. However, a pregnancy in 2015 resulted in a subsequent weight gain of 100 lbs.
When Broek met Janice in 2018, she was 520 lbs. Broek & Janice began working on a patient self-management plan together that included diet counseling and lifestyle changes. Broek also addressed the depression by referring Janice for mental health therapy. After 6 months of Janice’s commitment to the self-management plan, there were no significant changes in her weight. Broek pondered possible reasons. “When things weren’t going the way I expected, I started looking for another explanation,” he said.
Broek discussed Janice’s case with the physician and recommended a referral to the metabolic clinic at the University of Michigan in Ann Arbor, Michigan. The physician deferred to Broek’s expertise, and the lengthy referral process began. 2018 was coming to an end, but the bond of trust between care manager and patient was just beginning.
In the summer of 2019, Janice was finally admitted to the University of Michigan’s metabolic clinic. She began vitamin and mineral supplementation, and was prescribed weight loss medications that, unfortunately, her health insurance would not pay for. Finally, revision of her bariatric surgery was discussed as well as an offer of genetic testing. Janice called Broek to express her feelings of fear and apprehension at the thought of genetic testing. With a little encouragement and moral support from Jon Broek, Janice decided to venture down this road.
In December of 2019, Janice called Jon with news that the results were conclusive of an extremely rare genetic defect, called SH2B1, which directly affects appetite and fat metabolism. Across the globe, this condition is extremely rare, with no known or published prevalence. With these findings, Janice was now eligible to participate in a trial study that involved a non-FDA approved medication called Setmelanotide. With a solid trust established between patient and care manager, Janice once again sought Broek’s advice. Jon encouraged Janice to pursue this unique opportunity.
Within 3 months of participating in phase 1 of the trial, Janice lost 30 lbs. This success enabled her to enroll in a long-term phase of the medication study which allows her and her insurance to receive this drug free of charge along with any associated costs such as testing and travel expenses. At first reluctant, but with one last word of encouragement from Broek, Janice shared her story at a February rare disease conference in front of an international audience. Janice’s smile was extra bright against the backdrop of her bronze tan (a side-effect of the medication) as she shared her journey from isolation and stigmatization to being seen as a human being and as an individual through the eyes of the team at the University of Michigan and by Broek, her care manager at Medical Advantage.
Medical Advantage has a team of care managers who, like Jon Broek, seek to find each individual face among the inhuman statistics of population health. As Broek shared the philosophy of care management at Medical Advantage, he explained the importance of stepping back and looking at all the factors that contribute to each patient’s story. “It often takes a team of professionals over a long period of time who never give up advocating for the patient,” he said.
Here at Medical Advantage, our care managers are trained to leave biases and assumptions at the door and look at each patient as a unique human being with a unique set of circumstances. Uncovering a rare disease was a definite “win” resulting from the team’s dedication to their patient, yet humbly walking beside the patient through each step of the journey no matter the health concern is the daily work of the care management team at Medical Advantage.
Editor’s note: To protect patient privacy, the patient’s name was changed for this article.
1 Ashish K. Jha, M. (2019, August 06). Population health MANAGEMENT: Saving lives and saving money? Retrieved March 04, 2021, from https://jamanetwork.com/journals/jama/fullarticle/2740704