With more and more of the population focused on wellness and healthy lifestyles, health plans are doing what they can to provide and promote quality among members.
Plans are working to identify risk factors and potential problems among members, while educating them on how to access the right care at the right place at the right time.
“Plans should make sure members are focused on wellness and prevention on the front end, so they are educated and learn how to control a disease,” says Sandra Brower-Stenger, RN, MSN, the senior director of medical operations at AvMed Health Plans.
It’s worth it to encourage prevention, adds Brower-Stenger, because early treatment is much less costly and less detrimental to a member’s livelihood and quality of life.
Smart Business spoke with Brower-Stenger about how to take advantage of the quality care initiatives health plans have put in place.
What are the risks of not focusing on quality care or taking advantage of these initiatives?
Employers should encourage their employees to focus on wellness and health care from the onset of their employment. Then, employees will know how to access care and services at the appropriate times. If health related problems arise, these problems can be quite costly, even if the employee has insurance. Costs come back to the employer in the form of an experience rating, and to the employee in the form of high deductibles or high co-insurance.
Taking advantage of preventive measures on the front end is usually less expensive. For example, early detection of breast cancer via a mammogram has a lower cost and much higher success rate for survival; it can be more costly and possibly fatal if the cancer goes unchecked.
Which measure in quality care is the most important?
All measures of quality are important, but quality care measures that focus on prevention, such as immunizations, early detection or wellness, should be a strong focus. Initiatives that encourage the identification of poor lifestyle or behavior choices and then change those behaviors in order to eliminate high-risk conditions are also important.
There also needs to be a heightened awareness about measures and activities that can help members avert crises. For example, there are many diseases that people can control. Crises can be averted by educating people on how to control and live their lives within the parameters of the disease. Show them what they should and shouldn’t do, and what types of preventive services to access, i.e., obtaining specific health screening procedures or tests.
Employers can be supportive of employees who need to have preventive tests done a couple times a year. Still to this day there are not a lot of physician offices open after hours or on Saturdays. Employees oftentimes have to take time off work for these appointments if their employer is not supportive of these preventive initiatives. This can make it more difficult for employees to access these services and get the right care.