Health plan pilot engagement program produces real-world results

February 18, 2015

Making sure its members get the right care at the right place and at the right time drove Independence Blue Cross to launch a two-year pilot program last fall with consumer engagement firm Accolade.


SPECIAL REPORT: Engaging members

 

Shortly after Independence Blue Cross launched a member engagement initiative last fall with Accolade, an Accolade health assistant received a call from a woman whose baby was suffering from a facial deformity. The mom was seeking help with a grant application because the treating hospital refused to schedule more surgeries due to a $7,000 balance from previous surgeries. The health assistant who took the call realized that the hospital billing was off by $5,000. After advising the hospital of the discrepancy, the bill was adjusted, allowing the family to move forward with the surgery.

Another member called looking for an in-network ophthalmologist, but a health assistant, sensing something more, dug deeper. After initial reluctance, the member revealed she had a history of glaucoma and was seeing intermittent rainbows and halos. A nurse from Accoldade joined the call, and the member revealed that she had run out of eye drops months earlier. Subsequently, a doctor’s appointment was scheduled and the member was connected with a pharmacy that could deliver the eye drops to her home. At her first appointment, her new doctor told her that, if treatment had been delayed one more month, she would be blind.

In early Dec

ember, a health assistant spoke to a member who rarely seeks care except for a quick biennial physical at work. He was inquiring about urgent care for worsening back pain, but discussion revealed that he had recently stopped taking his blood pressure medication because he “felt better.” Alarmed, the health assistant asked the member to check his blood pressure while on the line; a “very high” reading led to scheduling of a next-available doctor’s appointment, and the member was advised to resume his blood pressure medication. He now sees his primary care physician regularly to control his chronic hypertension, and the health assistant follows up with him regularly.

Making sure its members get the right care at the right place and at the right time is what drove Independence to launch the two-year pilot program last fall with consumer engagement firm Accolade.

NEXT: Program design and plans for the future

 

Several months into the program, the partnership has worked “amazingly well,” says Daniel J. Hilferty, president and chief executive officer of Independence, the leading health insurance organization in southeastern Pennsylvania. “We’re consistently hearing from members that they’re happy with the service.”

The pilot program serves 40,000 enrollees in 40 employer health insurance plans, says Hilferty, a Managed Healthcare Executive board member. Since its fall 2014 launch, it has engaged nearly half of those members. Tom Spann, Accolade’s chief executive officer, notes that the number is “many times more than conventional solutions such as disease and case management, and we’re steadily working our way toward the more typical 60% to 70% engagement rates that we’ve seen with our large employer customers.”

When program members call Independence, they’re automatically routed to Accolade, says Hilferty. Each member is then assigned an Accolade health assistant who, in turn, is supported by a team of nurses, doctors, social workers and other specialists.  “From that point on, every time they call they are connected with the same assistant, who becomes a trusted advisor-learning the member’s medical history and personal preferences and addressing their needs,” he says.  

Spann says that health assistants develop highly personalized and integrated plans that factor in the member’s health status and emotional, financial, and social issues that affect care decisions.
Both companies are closely monitoring outcomes. “We’re looking at the member experience and the financial impact on the cost of healthcare,” says Hilferty. “We’re also tracking the program’s ability to reduce re-admissions and to find other ways to reduce or streamline costs and increase the quality of care.”

Current member satisfaction rates “are nearing 99%,” says Spann. Each month, members “share...perspectives about our service, and we read each comment to ensure that we’re on track and continually improving.”

“I fully anticipate increasing the number of Independence members that Accolade will serve,” says Hilferty. “They get it, and our members welcome the personal touch. I am certain that our relationship with Accolade will grow exponentially.”

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