Newsroom | Collaborative Care

Collaborating with providers to help members close gaps in care and achieve optimum health.

Focusing on Preventive Care and Chronic Conditions

Health Care Service Corporation (HCSC) is an ally to its network providers who deliver quality care to its more than 17.5 million members. To fulfill that promise, it employs about 3,400 clinicians, including doctors, nurses, social workers and pharmacists, who help ensure members get the care they need. 

Last year, the company expanded an initiative aimed at closing gaps in care by targeting preventable conditions that most affect members’ health and well-being. HCSC focused on six areas of health — cancer screenings, immunizations, diabetes, cardiovascular care, behavioral health and maternal and infant health — to help nudge members in its five plans get recommended preventive screenings and manage chronic conditions.

Research published in the American Journal of Managed Care shows early disease detection enables prompt treatment that can prevent disease progression and poor health outcomes.

“We are not there just to pay claims,” says Dr. Monica Berner, HCSC’s chief clinical officer. “We're there to help each of our members become the healthiest that they can.”

Part of the work involves using claims data and other information to identify members in need of recommended services and screenings and informing members and providers about those gaps by letter, email, phone or text message.

“If we find that there's a population of folks that aren't having their diabetes managed or the kiddos haven't had their immunizations, we directly will reach out to their clinicians and to those members and remind them of the importance of these services,” Berner says. “They might just need some reminders that you're 50 years old and it's time for your mammogram or it's time for your colonoscopy or your kiddos are headed to school. It's time for their immunizations.”

For example, last year, the Illinois plan and its South and Westside Chicago neighborhood centers started a three-year colon cancer screening initiative. It partnered with the American Cancer Society, Colorectal Cancer Alliance, Gilda’s Club and Sinai Chicago. The Morgan Park and Lawndale centers, located in some of Chicago’s most underserved ZIP codes, held events where medical experts and colon cancer survivors educated residents about the disease and explained the importance of early screening and diagnosis.

“The audience was very interested in the survivor stories,” says Laron Taylor, director of the Chicago neighborhood centers. “They had many questions about the symptoms and were very interested in hearing their experiences with overcoming colorectal cancer.”

Those who participated were offered free at-home colorectal cancer screening tests, fecal immunochemical test (FIT) kits, an effective and less invasive screening for colorectal cancer.

For years, HCSC has offered FIT kits to targeted member populations to screen themselves for colorectal cancer and return them for analysis. In 2022, it sent free FIT kits to 92,132 eligible members, and 13,480 performed the screenings. The company recommended 714 members schedule follow-up colonoscopies because their FIT kit results were abnormal.

In Montana, Oklahoma and Texas, teams used retinal cameras at community events and provider clinics to perform eye exams on members with diabetes, which can damage blood vessels in the retina, causing blindness. Several members screened with the cameras were diagnosed with diabetes-related eye conditions.

“The screenings saved the eyesight of those people,” says Janice Hoag, the Oklahoma plan’s director of clinical strategy and care models. “We’re looking at different ways to engage people.”

The New Mexico plan used claims data and other information to identify about 300 Medicaid members diagnosed with diabetes possibly at high risk for complications. It offered to connect those members with care managers, who could help them find doctors, diabetes education and community resources to better control their conditions.

Many members agreed to engage with care managers or other community care coordinators to get regular screenings, education, medical devices or other services.

“It made sense to focus on members with diabetes,” says New Mexico Plan Medical Director Diana Weber, adding that 12% of the state population has diabetes. “We would love all eligible members to be enrolled in care management.”

Additionally, the Texas plan texted certain members with gaps in breast cancer screenings to encourage and help them schedule mammograms.

“We have people in support of our members working tirelessly 24/7,” Berner says. “Just walk with them day to day, to help them navigate whether it is cancer treatment, whether it's just heart failure that is exacerbated, whether it is something to do with a loved one. We really do see that our role is to support our members throughout that health care journey.”

Health Care Service Corporation, a Mutual Legal Reserve Company.