How can employers and plan members receive information on health plan programs?
Health plans educate in a multitude of ways. One way is through newsletters, which can be tailored to the specific audience. A member newsletter may talk about different disease processes, how to better understand the health care system, and what preventive activities are scheduled based on their age, gender and high risk factors.
Employer group newsletters could be geared toward items such as wellness programs, activities and initiatives to implement for the entire employee population. Employers should be educated on the health plan’s offerings, as far as wellness and prevention activities. Studies have shown that employers who support wellness and prevention activities have a much higher participation rate of employees that are engaged in wellness activities than employers with a hands-off approach.
How do plans manage costs by coordinating care?
Health plans should have different types of programs to address a variety of different issues, such as case management, complex case management or disease management programs. Disease management looks at populations of individuals with a specific disease and helps the identified members learn about their disease. For example, a health plan can look at all of the diabetics enrolled in the health plan and identify the biggest opportunities for improvement. This could be getting them a certain test, controlling test results or mass education. It’s understanding the individuals and giving them the right tools so they can better manage the disease.
Case management is a more high touch program. A member may have more complex needs, and may have challenges navigating the health care system, utilizing unnecessary resources if he or she doesn’t receive attention from the health plan. Case management works with the member and his or her physician to coordinate care so inappropriate or unnecessary services are not being delivered.
How do plans get non-compliant members involved in health care services?
Health plans should get individuals with chronic illnesses engaged in understanding their diseases and health care needs by educating them on the importance of the care, helping them understand what will happen if they do not receive this care. They should also understand how this would affect their quality of life now and in the future.
Another way to motivate members is through incentives. Members can be rewarded when they achieve a specific goal or change a certain behavior. Incentives can be money, gift cards, prizes, drawings, or even a partial reimbursement for services.
Sandra Brower-Stenger, RN, MSN, is the senior director of medical operations at AvMed Health Plans. Reach her at (305) 671-5437 or [email protected].