A DAY IN THE LIFE
Because Anthem insures many people across the Commonwealth , Kentuckians are the second “ population ” I serve .
As I started in my role , I took a high-level look at the data out there for our state and the current status of our health outcomes . Compared to other states , there is a lot of work to be done to improve the health of Kentuckians . To break this down further , we are employing a new tool at Elevance Health called the Whole Health Index . 3 This combines various data sources across the spectrum of health and well-being in order to identify and address the needs of the whole person , not just their physical illnesses . We have learned that we need to be more than “ health insurance ” to make meaningful improvement in the health of our patients . The DxCG stands for Diagnostic Cost Group / relative risk score .
Health is a secondary factor when you are suffering from food insecurity , housing instability , financial hardship or lack of social support . By addressing these broader factors , we can improve health and also help to elevate patients to a place where they are able to focus on their health . Not only are we supporting individuals through our case management teams , but we are looking for interventions that can be implemented on a larger scale — for example , state-wide — in order to make a true impact on the health of Kentuckians . Our case management team can encourage one person to get an immunization at their doctor ’ s office or pharmacy , but we can work with community organizations to arrange vaccines to be administered in locations across the state where access may be limited in order to reach hundreds or thousands of people at a time . Case management associates can get Meals on Wheels delivery for a person who is not able to get to a grocery store or cook meals . As an organization , we are also addressing food insecurity in our Kentucky communities by partnering with Feeding America to ensure food is distributed to areas of need . We can support programs and policy initiatives such as the Kentucky Double Dollars program , where incentives are provided for farmers markets to increase access to healthy foods . 4 Expanding our myopic view to encompass the health of a whole person and of entire communities will drive bigger changes in the health of the Commonwealth .
Quality of Care
Quality is a major focus in my position , and it comes in many shapes and sizes . I serve as Chair of the Kentucky Commercial Credentials Committee , which is made up of physician peers from the community ( not employed by our company ) who review the credentials applications of providers and facilities . We make sure the most qualified health care providers are the ones taking care of our members . We make sure the facilities available to our members operate above standards and are safe .
I provide internal quality of care reviews and serve as a member of our company ’ s Quality Committee . When concerns are brought to our attention by patients , providers or internal staff about the appropriateness of medical care , these cases are reviewed in great detail by a nurse and medical director to ensure that the standard of care is upheld for our patients . Complex quality cases are discussed in the Committee to ensure all angles of the case have been considered before making a final determination on the case .
I also work with our quality experts to identify areas of need for our patient population . We analyze data , such as HEDIS measures and other quality measures to determine what areas we focus on for quality improvement each year . Quality improvement may include internal efforts such as outreach to members to encourage them to complete recommended complete screening tests or immunizations . It might also include adjusting our provider incentives to focus on the identified areas of need .
There are many things I could not cover here , but please contact me if you are interested in learning more ! I certainly didn ’ t imagine that I would end up where I am in medicine today when I started on this journey 23 years ago . In fact , I didn ’ t even know this career path existed ! I look behind me and I am thankful for my previous experiences as a family physician , medical educator , flight surgeon and public health practitioner , which have shaped my perspectives in medicine . With this unique lens , I look forward to the future and to finding ways to advance the health of the people of our Commonwealth . In this moment , I find joy in being exactly where I am , even if it is the “ Dark Side .”
References :
Attempting to work at home with my faithful companion , Rumpleteaser , who enjoys Teams and Zoom calls at the least convenient moments .
1
Kindig DA . Improving Population Health . Accessed August 29 , 2023 from : https :// www . improvingpopulationhealth . org / blog / what-is-population-health . html
2
Goodman RA , Bunnell R , Posner SF . What is “ community health ”? Examining the meaning of an evolving field in public health . Prev Med . 2014 Oct ; 67 Suppl 1 ( Suppl 1 ): S58-61 . doi : 10.1016 / j . ypmed . 2014.07.028 . Epub 2014 Jul 26 . PMID : 25069043 ; PMCID : PMC5771402 .
3
Chi WC , et al . The Whole Health Index : A Practical , Valid , and Reliable Tool to Measure Whole-Person Health and Manage Population Health . NEJM Catalyst 2023 May DOI : 10.1056 / CAT . 23.0015 . https :// catalyst . nejm . org / doi / pdf / 10.1056 / CAT . 23.0015
4
Kentucky Double Dollars accessed August 30 , 2023 https :// kentuckydoubledollars . org
Dr . Caloia ( she / her ) is a family medicine physician , Air Force veteran and Plan Performance Medical Director at Elevance Health .
October 2023 11