Health Plan Sponsors: Consider Adding Care Management to Benefits

For health plan sponsors, care management programs can benefit both employees and their employers. Not only can they help employees gain better control over their health and well-being, but they also enable plan sponsors to contain healthcare costs. For these reasons, it is important to understand care management’s value proposition.

Care Management’s Value to Plan Sponsors 

Plan sponsors are continually seeking ways to reduce their healthcare expenses. They use pharmacy benefit managers (PBMs) to control drug costs, provide on-site wellness seminars and health screenings, and offer their plan members access to advanced telehealth services that avoid unnecessary visits to hospital emergency departments, urgent care centers or physicians’ offices and their associated costs. Care management services are also another way to help plan members remain compliant with their medical treatment, increase their knowledge of their medical conditions, and learn about behaviors that can negatively or positively affect their health. Through the personalized attention an experienced nurse care manager provides to those individuals with complex or chronic medical conditions such as hypertension, chronic obstructive pulmonary disease, heart disease, and diabetes, and/or comorbidities (more than one medical problem), serious incidents and setbacks and their related costs (i.e., hospitalizations, new drugs, etc.) can be avoided and their overall health outcomes significantly improved. 

The addition of care management as an employee benefit also differentiates the organization as being employee-centered with management who is concerned with their employees’ well-being. This can be important in both retaining existing employees and attracting new ones; especially important in today’s labor shortage market affecting many industries.

How Plan Members Benefit from Care Management

For individuals with serious medical conditions, having a dedicated nurse case manager to confide in and discuss their concerns with relieves stress and helps motivate them to choose healthier behaviors. The nurse case manager also serves as a go-between with other members of the individual’s medical team and can ask questions of, for example, a cardiologist, on behalf of the individual/their patient. As a fellow medical professional and one with deep clinical knowledge and experience, the nurse case manager can better articulate a patient’s concerns, drilling down to specifics which are helpful in finding solutions or assuaging the individual’s concerns. In the end, the individual gains greater peace of mind, a deeper understanding of his/her medical condition, and ultimately, the opportunity to achieve a better quality of life.

Avoiding Deferred Medical Care

Care management services also play an important role in an individual’s avoidance of necessary medical care. The nurse case manager can communicate the need for a special treatment, drug or surgical procedure and why avoiding it can lead to much more serious medical problems. This of course is critical to an individual’s well-being, but also aids health plan sponsors in avoiding a costly intervention which could have been prevented if other measures were taken earlier. During the pandemic, this phenomenon of delaying necessary medical care was prevalent. And, while the pandemic may have represented short-term lower costs for plan sponsors, as soon as it subsided, costs increased and those related to delayed medical care represented higher costs than had the proper medical action not been delayed.

Giving Plan Members More Options and Increasing Health Parity

Leading care management firms today use many methods for communicating with their patients. From telephone and telehealth calls to in-person visits and texts, nurse case managers offer their patients many options for communicating with them. This helps eliminate any obstacles to building a trusting relationship, preventing adverse medical incidents, and contributing to improved care and health outcomes. It also evens the playing field for all individuals, generating greater health parity.