BENEFITS BUSINESS
By Len Strazewski
Early users give high ratings to health care management services
A growing number of employers are expanding their health care benefits ... with a variety of care management services that enhance and support employee health--and may eventually lower health care costs.
When should employee health benefits begin? At the first medical treatment? At the first symptom of a serious disease? Whenever employees have questions about their health?
A growing number of employers are expanding their health care benefits beyond traditional indemnity health plans or managed care plans that treat acute and chronic conditions only as they are reported to doctors and hospitals, with a variety of care management services that enhance and support employee health--and may eventually lower health care costs
These new health care management services, which can include individual case management, chronic disease management, health advocacy services and nurse-staffed health information lines, are usually well-received by employees, say care management service providers, and help raise overall satisfaction for all health benefits.
The services, which can cost as little as $1 per employee per month, also provide opportunity to agents and brokers seeking new products that will open doors to corporate employee benefit managers.
Philadelphia, Pennsylvania-based Intracorp, a division of CIGNA, offers a comprehensive package of health care management services to employers and more than 28 million CIGNA health plan participants and corporate self-insured plan participants. The services include case management for short- and long-term disability cases, disease and maternity management and a nurse-staffed health information line for health plan participants.
According to a survey of 800 Intracorp service users conducted by Marketing Leverage, Inc., a survey research company, health plan participants respond very positively to the services, with more than 90% reporting positive ratings for whichever service they accessed.
The Intracorp Nurse line is one of the most popular services, says Kathleen M. Leone, vice president of utilization management. About 95% of survey respondents rated the service positively, she says.
The nurse line service allows participants to speak to a nurse operator 24 hours a day/seven days a week to help determine if a hospital emergency room visit is warranted, get information in plain language about 5,000 topics, treatment and medications, get specific instructions about treating a child's illness and make a treatment or provider decision. Participants can also access similar information from the Intracorp consumer health care Web site healthinfoseeker.com.
Leone says the nurse line is designed to empower individuals with medical information that they need to make educated decisions about their health and wellness. About 65% of respondents said that a conversation with a nurse line operator influenced their health care decisions.
The experiences also translated into higher levels of satisfaction with their overall health benefits, with about one-third of respondents reporting greater satisfaction since they accessed the additional health care management services.
The movement toward consumer-driven health plans which force employees to take greater responsibility for health care spending decisions is also stimulating interest in health care management services.
"Health advocacy and health care management services fit very naturally with consumer-driven health plans," Leone says. " As employees become more responsible for their own health care decisions, they will need more information and guidance about their options," she says.
Do the services actually save employers money? Leone says that various surveys conducted by employers and insurers indicate a strong return on investment, as measured by lower claims costs and better, less expensive care choices. However, she says greater returns may yet be tallied as employers and health plans more carefully measure health care management impact on job stress, health lifestyles and productivity as well as faster return to work after medical treatment.
Optum, a health care management services company in Golden Valley, Minnesota, also markets health care management and advocacy services and a nurse-staffed employee help line. The company serves about 22 million employee health plan participants,
Optum nurse line operators assist callers to learn self-care for minor illnesses and injuries, understand diagnosed injuries, evaluate treatment options, learn about specific medications, prepare questions for doctor visits and develop healthy living habits.
Callers also have access to more than 1,700 recorded messages about health issues in an audio health information library. Transcripts of the messages are also available at the company's online consumer health Web site, HealthForums.com
The Web site also features an extensive library of proprietary health information, online discussions with clinical professionals, daily news summaries on health care and the opportunity to submit questions to health care professionals.
In March, Optum announced an agreement with Matria Healthcare, Inc., in Marietta, Georgia, to provide nurse triage services to individuals participating in Matria's disease management programs which are marketed to employers and health plans. Matria offers disease management programs for diabetes, cardiovascular diseases, respiratory disorders, high-risk pregnancy, cancer, chronic pain and depression.
Matria and Optum have electronically integrated their disease management, allowing participants to report medical conditions and details to nurse line operators who can evaluate the conditions based on disease or condition management criteria. The criteria trigger an alert to the Optum nurse that the caller is enrolled or qualified for a disease management program, allowing consultation for acute conditions.
The company says that 97% of callers report being "satisfied" or "very satisfied" with the help line and 92% say that they have followed an action plan that they developed with nurse line operators, contributing to a reduction in inappropriate medical care and medical expenses.
Integration of medical information lines, disease management and other health support services is the wave of the future for employer-based health benefits, says Camille Halton, a health care consultant with Hewitt Associates in Lincolnshire, Illinois.
"Case management has become much more important to employers as health care costs continue to increase, and the process is evolving rapidly toward more comprehensive care management, incorporating not only management of hospitalizations and current treatment, but also disease management for chronic conditions and after care," she says.
"Employers are also incorporating a health advocacy approach to their support services to provide help to employees in managing their health benefits as well as their lifestyles for best health care results," she says.
Integration of health plan information into health care support services is critical, Halton adds. "Employees often have difficulty managing and understanding their health plan benefits. Integrated health advocacy and health information services can assist employees in not only choosing the best care options and practices, but also making best use of their health benefits in specific care situations."
Halton says she believes health care management services certainly will pay dividends in lower health plan utilization, more appropriate care, fewer hospital re-admissions and potentially less expensive preventive care. But she also expects that future research is likely to reveal savings in workers compensation costs, faster return to work after occupational or non-occupational injury and overall productivity.
Employees also appreciate the availability of the resources, even though utilization is not always high when programs are first introduced. "In general, we have found that health plan participants are very open to care management and that employers are open to the additional services and costs if they understand how much their employees appreciate the resources," he says. *
The author
Len Strazewski has been covering employee benefits issues for more than 20 years and is employee benefits editor of Human Resource Executive magazine. He has an M.A. in Industrial Relations from Loyola University.