Healthcare GPS - Personalized Support to Maximize Your Benefits
“There's a lot of people who don't manage their conditions and a lot of times it comes down to affordability. If you can't afford your prescription, maybe you're not motivated to go in and see your doctor.”?
A recent Modern Healthcare article, “Insurers, employers start helping more with chronic disease,” highlights the impact and growth of case management and other chronic condition management programs offered by health insurers. As a nurse who previously practiced in a clinical setting and now working in population health management on the payer side of the industry, it’s my perspective that not enough people are aware of the resources their insurance company has – experts on claims, your specific benefits, and even nurses and medical staff who can support and guide you through your health care journey.??
Whether you’re looking for a different doctor or need guidance on treatment options based on your health plan coverage or a new diagnosis, call your insurance company and ask to speak to a case manager. Chances are they have a highly trained case management team ready to help. Not only are these case managers registered nurses; they also have a unique set of resources that the doctor or nurse at your provider’s office doesn’t have – access to detailed information on your individual medical benefits. This includes claims history, risk analytic tools, and databases that show the quality outcomes of numerous providers throughout the country. With this knowledge, they can present treatment options based on not only your medical history but the type of medical coverage you have or the highest-rated medical centers. ?
As illustrated by the quote above, it may become difficult for an individual to adhere to medication regimens or treatments that one cannot afford. A case manager can guide you to options that may better work with your health plan or can suggest programs to aid in your costs for certain prescriptions.?
Beyond possessing this unique expertise to provide advice for your physical health needs, case managers will often develop a trusted relationship with patients over the course of regular conversations and coaching. Mental and behavioral health conditions are a growing concern and can be exacerbated by the stress of a chronic physical health condition or a new medical diagnosis. Case managers can provide emotional support or direct you to community resources you may not otherwise realize are available.??
For employers, there are numerous positive impacts to working with a benefits partner who can provide tailored programs based on the health needs of their employees. Healthier employees can equate to reductions in medical costs, absenteeism, and presenteeism while providing better engagement and more. Working with their benefit partner, employers can enhance the utilization of these valuable resources – who are a mere phone call away. Just pick up your health insurance member ID card and your cell.?
As quoted in the Modern Healthcare article, “Everybody wins if the patient is healthier.”?
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