February 28, 2019
There’s no one-size-fits-all approach when it comes to helping employers and their workforces manage health care costs and access resources. That’s why Health Care Service Corporation (HCSC) and its health plans in Illinois, Montana, New Mexico, Oklahoma and Texas provide employers with data-driven, customizable solutions that provide person-to-person engagement and take into account the critical link between physical and mental health.
Person-to-Person Care Coordination
A June 2018 survey of HCSC’s largest employer customers found that 83 percent were considering personalized care models to help their employees navigate their health care decisions, such as identifying appropriate and cost-effective sites of care and learning how to proactively engage in their wellbeing. HCSC developed Health Advocacy Solutions and Wellbeing Management to address this need and deliver a customized experience that helps connect the dots between providers, case managers, specialists and digital resources.
Health Advocacy Solutions (HAS), available to self-funded customers, gives employees a single point of contact, a personal health advocate, to serve as a convenient resource for their health care needs. Health advocates can answer questions about benefits, seamlessly leverage the expertise of clinical nurses, pharmacists and benefits experts and help members identify where to go for care – including Virtual Visits and the bilingual 24/7 nurse line to help avoid high-cost emergency room or out-of-network visits. A year into its launch, HAS has provided participating group employers with an average of $40 savings per employee per month.
Wellbeing Management, available to both self-funded and fully-insured customers, leverages targeted clinician outreach and self-guided digital tools to improve health outcomes and increase member participation. Wellbeing Management engages every member, from those with chronic and complex conditions to individuals who want to maintain a healthy lifestyle. The solution provides members with customized online education and one-on-one coaching to encourage healthy behaviors. Clinicians proactively reach out to the highest-risk members to help improve condition management and quality of life. To date, HCSC has experienced a 2x increase in engagement among participating members.
Enhanced Behavioral Health, available beginning July 1, 2019, to both self-funded and fully-insured customers, provides person-to-person outreach and digital resources help members understand and address their behavioral health needs, from short-term life events to mental illness and substance use disorders. An integrated risk identification and outreach team of behavioral, medical and pharmacy staff proactively reaches out to at-risk members, such as those with potential opioid or substance abuse issues, to guide them toward appropriate behavioral health doctors and resources.
Integrated Pharmacy program, available to self-funded and fully-insured customers, recognizes the link between physical and behavioral health in treating the whole person. HCSC uses pharmacist and clinician outreach to help educate and actively guide members toward the most effective and cost-efficient pharmaceutical drug options and convenient centers of care. HCSC’s pharmacists connect directly with members to discuss their pharmacy drug treatment plans and provide generic drug recommendations. Clinicians also reach out to members who are using specialty infusion drugs, such as for kidney dialysis or chemotherapy, to suggest in-network providers such as a doctor’s office, home health care, or standalone infusion center. This outreach helps engage members in their care and educate them about pharmaceutical drug options and centers of care that could help save them money and increase convenience.
Whether it is a parent caring for a sick baby at 2 a.m., a professional needing a prescription filled while on a business trip or a college student seeking a therapist’s counsel, HCSC’s Virtual Visits, powered by MDLIVE, provides members access to quality care from their personal devices. Available to self-funded, fully-insured, small and large group customers, Virtual Visits provides access to board-certified doctors and behavioral health therapists via phone, online video or mobile app 24 hours a day. During a two-year timeframe, 85 percent of members who used Virtual Visits avoided a higher-cost setting, including emergency room visits, resulting in $14.5 million in savings for customers.
Engagement and Price Transparency
Prices for the same medical services can differ by thousands of dollars across health care facilities within the same region and health plan network between as much as 300-500 percent. Available to self-funded customers, Member Rewards provides a cash reward when a quality, lower-cost provider is selected from several possibilities for the same medical service or procedure. Member Rewards uses Benefits Value Advisor, a live health care member advocate, to guide members through the health care system. Benefits Value Advisors enable members to identify the best-value physicians and facilities by helping them to:
Since the program’s launch in 2017, Member Rewards has provided members with more than half a million dollars in rewards – and that number is expected to grow in 2019.