Integrating utilization and case management for optimal results

Medical management programs are typically comprised of multiple services designed to help control health care costs and ensure optimal health outcomes for employees.

“While these sorts of programs can be used individually, they are really intended to work together to provide an integrated approach to managing an employee’s total health,” says Amy Cleveland, HealthLink director of Medical Management.

Employers who don’t have a complete understanding of medical management programs may be missing out on the many advantages of an integrated approach by “carving out” or removing certain programs and services.

“When employers leave even one medical management service out of their plan, the program does not work as intended, which can put the good health of their employees and their spending at risk,” Cleveland says.

Smart Business spoke with Cleveland about integrating medical management.

What is utilization management?

Utilization management (UM) consists of multiple programs designed to encourage appropriate use and performance of medical services in accordance with evidence-based guidelines. Typically, UM consists of pre-certification reviews for hospital admissions, certain medications and high-tech imaging services, such as MRIs and CAT scans, as well as continued stay review, discharge planning, proactive screening for case management (CM) and more. These services can ensure employees get the right level of care at the right time, and that their treatment meets the health plan’s standards.

How should CM work?

CM nurses are responsible for developing individualized care plans for employees identified as at-risk for high utilization and/or high dollar claims. These plans assist employees with complex care needs, improve their experience, promote safe and timely transitions in care and encourage efficient delivery of services and cost savings. The CM team’s goal is to assist in an employee’s recovery to help them navigate the health care system and offer added support.

What are the advantages of integrating these programs?

When UM and CM are fully integrated, it allows for a comprehensive approach to managing employees’ health. Employees can be proactively screened during the UM process and clinical reviews to see if they are a candidate for CM. These high-risk employees can then be engaged much sooner, which leads to better health outcomes. This sort of integration gives CM teams the ability to engage employees in real time, rather than using past claims data to determine eligibility. It also allows for regular communication and coordination between the UM and CM nurses to ensure care plans are as customized and patient-focused as possible. This elevates a medical management program to real-time engagement in the quality of care.

What are the downfalls of carving one of these services out?

When one program is carved out, the other cannot work as effectively. If an employer chooses CM services, but not UM, employees can no longer be pre-screened and engaged in real time. In this instance, utilization and spending reports would be the only tool used to attempt to identify high-risk employees. Often, these employees don’t need services anymore. The opportunity to help employees and contain costs is missed.

How can employers decide if integrated medical management is right for them?

For many employers, cost containment is a driving factor for considering a medical management program. Unfortunately, most employers don’t fully understand the major advantages to employee health and cost containment opportunities that a complete, fully-integrated program offers.

Employers who are considering a medical management program should talk to their broker, third party administrator, network partner or carrier to be fully educated about the impact a medical management program can have on their health plan.

Insights Health Care is brought to you by HealthLink

Preventive care can help employees avoid medical issues, lower health costs

Preventive health measures and screenings may help prevent 85 percent of illness and disease, according to a 2013 Institute of Health Metrics report. Employees who receive the screenings and vaccines recommended for their age and gender may be able to address potential issues quicker, or avoid them all together. This can help save money for the health plan and the employee.

“Many employees tend to only use their health plan when they’re sick,” says Julie Bukowiec, senior medical policy analyst at Anthem, Inc. “These employees often miss out on advantages of preventive care, which could lead to more serious medical conditions and out-of-pocket spending.”

Smart Business spoke with Bukowiec about how simple education on preventive care can go a long way to helping change the way employees use their health plan.

Why are health screenings important?

Regular health screenings may uncover a potential issue early. For example, glucose screening could reveal pre-diabetes, a precursor to diabetes. At this point, lifestyle changes can prevent progression to type 2 diabetes. Preventive health exams may also reveal previously undetected conditions, such as uncontrolled hypertension, a leading cause of heart disease and stroke.

The Centers for Disease Control (CDC) indicates an estimated 13 million people have undiagnosed and untreated hypertension. In 2015, an estimated 30.3 million Americans were living with diabetes. Approximately 7.2 million of these people were undiagnosed. In both of these conditions, there may be not any signs or symptoms of the disease in the early stages. Early diagnosis and treatment, however, can reduce the associated risks.

What are some recommended screenings and vaccines for adults?

All individuals should undergo an annual comprehensive physical exam that includes height, weight and blood pressure. Some screening recommendations are based on age and gender. Women should receive breast exams every one to three years, up to age 40, and then yearly. Glucose screening for type 2 diabetes should begin by age 40. At age 50, all individuals should be screened for colorectal cancer.

Recommended vaccinations are largely based on age, with the majority of aimed at infants and children. But everyone should receive an influenza shot every year.

How do employees know which preventive care they should receive?

Preventive care recommendations are published by nationally recognized organizations, like the CDC, the United States Preventive Services Task Force and the American Heart Association. These recommendations are available on the sponsoring organization’s websites. Individuals also should talk to their health care provider about what is recommended based upon their circumstances.

What role can employers play in encouraging employees to receive preventive care?

Education is the key to encouraging employees to take advantage of their preventive care benefits. Inform employees that preventive care services aren’t subject to deductible, copayment or co-insurance payments. Some employees may be deterred by a lack of time. Employers can address this by setting up screenings at the office. Finally, attempts to encourage employees to access preventive care benefits should be ongoing, with follow-up reminders, such as emails.

Is there anything else employers should know about preventive care?

Currently preventive services are utilized at approximately half the recommended rate, according to the CDC. (Learn more at But regular preventive care is vital to improving and maintaining health. In addition to screenings and vaccinations, preventive care consists of counseling and education on topics, such as weight control and smoking cessation. Regular preventive care is the first step toward improving the health of your employees. Preventing disease or treating disease at the early stages can help keep health care costs down, lead to longer, healthier lives and encourage greater workplace productively.

HealthLink is a fully owned subsidiary of Anthem, Inc., one of the nation’s leading health benefits companies.

Insights Health Care is brought to you by HealthLink

Do your employees know how to talk to their doctor?

Health care can be complicated and even confusing. The best way for consumers to avoid being overwhelmed by uncertainty is to become health care literate. This doesn’t just mean learning big words, it also means knowing how to talk to doctors, so you have a better understanding of how to follow recommendations, take medications correctly and take charge of your health.

“When people don’t understand the information given to them by their doctors, they are more likely to be in poor health,” says Danielle Freeman, Network Education Representative at HealthLink. “That is why it is important for everyone to know how to talk to their doctor.”

Consumers who talk openly with their doctor and get the most from their appointments may also save money for their health plan and reduce their out-of-pocket costs. By being engaged and more proactive with their health, your employees can avoid issues that are more complex and the need for additional care.

Smart Business spoke with Freeman about how to help employees take charge of their health, and potentially save you both money.

How can an employee best prepare to talk to their doctors?

Being prepared can make a big difference in the success of an appointment with a doctor. Employees should have a general list of questions that they would like the answers to, such as what should I do to prevent or delay health problems, are there tests or screenings I should have, and am I due for vaccines? Employees should also be prepared to ask questions directly related to the reason for their visit.

In addition, having a list of all prescription and over-the counter medications, other drugs, vitamins and any herbal remedies they currently take can help the doctor get a full picture of their health. They should make note of any nutritional drinks or shakes, herbal teas, energy drinks, coffee and alcohol they drink.

Being prepared will show the doctor the patient is engaged and ready to do his or her part to maintain good health.

What about during an appointment?

During an appointment, employees should ask questions and then listen diligently while the doctor responds. They should feel empowered to ask for clarification if they don’t understand something, repeat the information back to the doctor and even have a piece of paper to take notes.

Before leaving the appointment, employees should know what their main issue is, what they need to do to treat it and why the recommended treatment is important. If they aren’t clear on these three points, they need ask for clarification, or schedule a follow-up appointment.

Employees should also pay close attention to any referrals that the doctor orders. The rule of thumb for referrals is to ask, “Why are we doing this?” Employees need to understand the need for the referral, the expected outcome, and whether or not the doctor or facility they are being referred to is in-network. If they are not in-network, they should ask if an alternative is available. The same is true when being referred for lab tests, imaging or other outpatient services. Employees should understand the need, expected outcome and whether or not these services are being requested diagnostically or if it will help their condition.

When lab, imaging or outpatient services are requested, employees should pay close attention to where they are being referred and shouldn’t be afraid to ask if there are alternatives. Freestanding facilities may have less out-of-pocket costs than services received at the hospital. Employees should always feel comfortable talking to their doctor about their concerns and finding the service provider that is best for them.

What if an employee is diagnosed with a medical condition?

When someone is diagnosed with a health problem, he or she needs to understand, in common language, what the issue is. Again, being prepared, asking questions and really listening while the doctor responds can go a long way in understanding the condition. Some common questions employees should ask about their condition include, what is the name of the condition, how it is spelled, what does it mean, what may have caused it and how long it will last? Employees should also inquire about treatment options and how they can learn more.

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How to help your employees be smart health care consumers

The term “smart health care consumer” has become increasingly popular. Now more than ever, employers are starting to understand the importance of helping their employees make informed health care decisions — but few know how to do it.

“When employees are smart about their health care choices, it has a positive impact on the company health plan, and the employees,” says Bridgette Bock, sales and retention executive at HealthLink. “But most employees won’t get there on their own, that’s where the employer comes in.”

Smart Business spoke with Bock about how to help employees make informed health care decisions.

How can employers help employees become smart health care consumers?

Employers have a unique opportunity to educate their employees on important health care topics. Typically, employers have direct access to employees and can communicate with them in a variety of ways, such as face-to-face meetings, email, a company intranet site or message boards. Plus, employees tend to more actively engage with information that comes from their employer rather than a third party, such as an insurance carrier.

The most important thing employers can do is use this opportunity to educate their employees. Sharing information about benefits, the best way to use those benefits, as well as a variety of health and wellness topics can help employees become smart health care consumers.

What should employees be educated about?

A great place for employers to focus their efforts is on the company health plan. Employers should consider educating employees on common health care terms, such as deductible, co-payment and co-insurance. They should also educate employees on the specifics of the health plan(s), including a detailed benefit and cost analysis to help them decide which plan is best for them. Providing a side-by-side plan comparison that highlights the important components, if applicable, can really help employees make educated decisions.

Employees also need to be educated about the best way to use their plan. This includes knowing the importance of staying in-network, how to find an in-network doctor and where to go for emergency care. Employers should talk to their insurance carrier or network partner about the materials available to educate their employees on these topics.

What about after an employee picks their plan? Should the education continue?

After employees select their health plan, employers should switch their focus to sharing information about how to use the plan effectively. Some topics to consider include where to go for care, the importance of shopping around before selecting medical services, and available tools like a provider finder, corporate discounts or telemedicine. These can help employees make informed decisions about using their benefits.

When is the best time to provide education?

It’s always a good time to educate employees. Don’t make the mistake of stopping education after open enrollment. Instead, employers should consider developing a yearly calendar with educational topics. Monthly or even bi-weekly communications is a great schedule for educating employees and reminding them about free tools and extras. It is also important to encourage employees to ask questions, so frequently asked questions or question-and-answer sessions are good topics to consider.

Again, employers should check with their carrier or network partner to see what resources are available, as many offer pre-developed educational materials and timelines. This can help employers cut down on the time and resources needed to educate their employees throughout the year.

What else can an employer do to help?

In addition to education, employers can incentivize employees to become healthier with company-wide programs such as a ‘know your numbers’ program or offering flu shots. These preventive programs can help employees avoid chronic disease and the need for additional care. Employers can also consider making the workplace healthier through initiatives like refreshing vending machines with better-for-you options or organizing healthy potlucks or fresh fruit and vegetable deliveries.

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The importance of educating employees about their health plan

It’s never been more important for employees to have a complete understanding of their health care benefits so they can get the most from their coverage.

For many employees, benefit information can be confusing and even overwhelming to understand. However, employers may have a unique opportunity to educate their employees about their health plan.

“The more familiar employees are with their benefits, the easier it will be for them to make informed health care decisions and use those benefits when they need them.” says Judy Dawson, sales and retention executive at HealthLink Inc. “Educated employees may also be more likely to use their benefits to proactively take charge of their health.”

When it comes to educating employees, knowing where to start can be half the battle.

Smart Business spoke with Dawson about five important topics to educate employees on so they can get the most from their health plan.

1) Benefit and plan summaries

Once an employee is enrolled in a health plan, he or she should review the summary of benefits and coverage and summary plan description documents, which are also referred to as SBC and SPD. These documents should be stored where employees can easily access them, such as on a company intranet or with the human resources department, and employers should educate employees about where to find them.

2) Member ID card

Employees’ member ID cards have a lot of important information that can be useful to them as they navigate the health care system and use their benefits. Health plan and network names, group and/or member numbers, and many important phone numbers are listed on ID cards.

Employers may want to consider creating an informational flyer that shows an example of an ID card with the important information highlighted. Employees should be educated on the importance of carrying their ID card with them at all times and how to request a new card if needed.

3) How to find in-network doctors

One of the most beneficial things to educate employees on is how to find doctors, hospitals and other health care facilities that participate in their health plan’s network. Benefits are always richer when receiving services from an in-network provider, which could save money for employees and the plan.

Employees should know that they risk paying more out-of-pocket or their services not being covered when they go outside of their network. No matter how they search — through an online provider finder tool, a provider directory or by calling customer service — all employees should know exactly how to find doctors who participate in their network.

4) Included products and services

If a health plan includes programs that can help employees better manage their health, such as case management, disease management or telemedicine, they need to be educated. Engagement is truly the key to success with health and wellness and cost containment programs, so it’s in the employer’s best interest to encourage participation.

The same is true for pharmacy, which is one of the most used benefits. Employees should be familiar with their pharmacy benefit manager and any prescription guidelines or restrictions so they can make the best use of these benefits.

5) Additional tools and extras

Most employees are surprised to learn about the amount of discounts and free extras that are available through their plan.

If there is a member portal or website available, that can often be an extremely useful tool to help employees maximize their benefits. Employers can also educate their employees about any discounts available on items they purchase, such as glasses and contacts or healthy eating and living products. Some health plans may even offer premium reductions for wellbeing assessments or preventive screenings.

For more tips on educating your employees about their benefits, contact your broker or network partner.

Insights Health Care is brought to you by HealthLink

How technology connects doctors with patients and saves money

In today’s age of on-the-go technology, consumers expect to be able to get the information or services they need quickly — often with just a click of a button. For many consumers, this includes how they receive medical services.

“As technology evolves, the way we communicate is evolving as well,” says Susan Lehne, acting manager at HealthLink. “This is true for how patients communicate with their doctors, which also could represent a cost-savings to an employer’s health plan.”

Smart Business spoke with Lehne about technology advancements in health care and what that means for employers and their health plans.

How has technology changed the way people communicate with their doctors?

Technology has drastically affected the way we communicate over the past decade. From email, text messaging, instant messaging and video chatting, we now have quicker, more on-demand options for how we communicate with each other.

With these advancements, there has also been a change in people’s expectations. For example, if someone’s preferred method of communication is email, they expect their doctor’s office to be able to communicate with them in that same manner.

As technology evolves, more people are questioning the status quo. Like any other good or service they purchase, they expect to have options when it comes to where and how they receive medical services. Why should someone have to leave their home or their office to talk to a doctor for a minor cold? People expect everyday activities, like going to the doctor, to become quicker, easier and more efficient because of technology.

What kind of programs capitalize on technological advancements?

Programs such as telemedicine, video chat and 24-hour nurse lines all capitalize on the latest technology. They are designed to make it quicker and easier for people to have their health care needs met via non-traditional methods.

Patients can now receive professional, effective and convenient care through access to nurses and on-demand consultations with U.S. board-certified doctors available 24 hours a day, seven days a week, without driving to the doctor’s office. These programs treat a variety of common ailments such as cold and flu, sinus infections and bronchitis, and in some cases, can even prescribe medicine.

Technology-based programs will never entirely replace face-to-face appointments for patients who prefer that experience, or in emergencies, but they can be a great option to get the care you need without leaving your home or work.

How can these programs help save employers money?

Technology-based consults cost less than a normal office visit, retail health or urgent care visit, and they can save hundreds of dollars over a trip to the emergency room (ER).

Often, these programs can be set up on a per use basis, meaning if an employee doesn’t use the benefit, the employer doesn’t pay for it. There may also be an option to include a co-pay, which means the employee covers some of the costs of the visit.

These programs can play a big role in avoiding unnecessary utilization and ER visits by helping employees decide where to go for care.

Are these products hard to implement?

Not at all. Implementing these programs usually only involves a little employee education.

Employers should check with their third party administrator or network partner about the tools and resources available for implementation. There is an array of marketing materials that can be used to educate employees and ensure the program is a success.

Insights Health Care is brought to you by HealthLink

Follow these tips for your next open enrollment

Open enrollment is a period each year when employees can sign up for their company-sponsored health plan, and as the insurance industry has changed, open enrollment has, too.

“The importance of open enrollment and the enrollment process have changed significantly over the years,” says Carla M. Flamm, sales and retention executive at HealthLink, Inc. “With all the new laws, extensions and even the increased use of electronic filing tools, open enrollment can be quite complicated for the average employer.”

For some employers, this complication is too much to add to their ever-growing list of to-dos, so they opt for the bare minimum open enrollment process. However, by not taking advantage of the unique educational opportunities open enrollment can offer, employers may be missing a chance to help save money for the plan and for their employees.

Smart Business spoke with Flamm about five tips to help employers with open enrollment.

1) Start early

The most prepared employers start planning for open enrollment four to five months before it starts. Employers should start by working with their broker, third party administrator (TPA) and network partner to examine the current plan and its performance. From there, employers can consider changes to make next year’s plan more effective.

Employers should also start planning for the actual enrollment process. They need to make some big decisions early on, such as whether or not they will require each employee to go through the enrollment process so they can collect updated information, or if only employees with changes need to re-enroll.

2) Collaborate with your partners

Employers should work collaboratively with their broker, TPA and network partner to plan for open enrollment early. Together, they should evaluate claim history and spending trends to determine if benefit changes are necessary. They should also compare the current plan offering to similar companies to determine how competitive the benefits are. These partners should be an employer’s trusted go-to resource for ensuring the health plan offering and open enrollment process meets all industry standards and regulations.

3) Educate employees

After making initial benefit decisions, employers should be diligent about educating their employees of their options, any changes that may affect them and how to make good purchasing decisions. Employers should consider giving employees educational materials that focus on selecting a plan that is right for them by encouraging them to evaluate components such as deductibles and out-of-pocket maximums, instead of focusing solely on premiums.

4) Be proactive with information

Employers should send benefit and educational materials to employees no later than two to three weeks prior to open enrollment. Employees need time to be familiar with this information so that they’re prepared to ask questions and make their selections during the open enrollment period. Don’t wait for employees to ask for these pieces, get them out as soon as possible. Proactive education means HR departments can spend more time enrolling employees in their plan and less time answering questions.

5) Consider a health fair

Hosting a health fair is the best way to optimize the open enrollment period and ensure success. Employees can get the information they need to make the best choice for them, and employers can take advantage of the face-to-face time to complete health and wellness screenings and enroll employees onsite, eliminating confusion and saving time. Employers that offer these fairs should be sure that every component of the health plan, including medical, dental, life and disability, etc., are present at the event so employees have a complete understanding. These events should be easy and convenient for employees to attend, with a potential incentive for attending.

Insights Health Care is brought to you by HealthLink

How to talk to your employees about their health

In today’s dynamic health care market, employers continue to look for new ways to curb spending and regain control of their health plan investment. For some employers, this means going directly to the source of the spending: their employees.

“Healthy employees are happier and more productive,” says Bridgette Bock, sales and retention executive at HealthLink, Inc. “Plus, without employee engagement, health and wellness and cost reduction programs are not effective. That’s why more employers are trying to make an impact by talking to their employees about their health.”

Smart Business spoke with Bock about strategies for talking to your employees about their health.

Why is it important to communicate with your employees about their health?

Communicating with your employee population about their health and different strategies for staying healthy is important because it helps keep the cost of care down. The typical consumer is not in the health care industry, so they may not be aware of the impact that their health has on their out-of-pocket health care spending or the impact it has on the cost of the health plan.

Employers that educate their employees about the available programs and services as well as best practices for staying healthy tend to have more success with their cost management strategies. Employers also have the unique opportunity to help their employees become more educated consumers by encouraging them to shop around and ask questions they may not have thought of on their own.

Do today’s employers have more of a responsibility to do this?

Absolutely. When an employer self-funds their health plan, it’s their money paying the claims, so they usually have more of a stake in keeping costs down. Self-funded employers are more likely to promote different incentive programs to engage employees and control costs.

However, with today’s rising cost of health care, even employers with fully-insured health plans should be taking an active role in talking to their employees about their health and educating them about the effect it has on costs.

What information is often misunderstood or not communicated when it comes to health and wellness plans?

Many employees don’t know that the majority of health plans cover standard wellness/preventive services at 100 percent, meaning there is no out-of-pocket cost to them. Employees also wrongly assume that if they never go to the doctor for a checkup, they’re saving money for the health plan. In reality, these employees may cost the health plan even more if they end up with health issues that could have been detected and treated through preventive visits.

Transparency is another topic that is getting more attention, but is still often misunderstood. Employees should be aware of the different transparency tools available to help them determine the costs of services so they can shop around and select the doctor or facility that is right for them.

What are the best methods and means to reach employees?

When deciding which methods may be most successful in reaching employees, it’s best to look directly at the employee population. Who are they? What do they do? Where are they located?

Employers should communicate with employees via the means that is best for the employees. For example, a large company with a diverse employee population may depend on the company intranet site or blog to distribute information. A smaller company may find that posting information in the break room is most effective. The method of communication should be unique to the workforce.

What else should business owners know?

Effective cost management entails more than simply adding a product to your health plan. Engagement really is key to success.

Employees should also understand that just because a doctor or hospital takes your insurance, it doesn’t necessarily mean they are in-network for your plan. If nothing else, an employer should educate their employees about the tools available to them to find in-network doctors and alternatives to the emergency room.

Insights Health Care is brought to you by HealthLink

How self-funding can help correct health care purchasing mistakes

Business owners may feel helpless when it comes to health care because it can seem as if it’s beyond their control. However, self-funded health insurance can actually correct some of the biggest health care purchasing mistakes.

Smart Business spoke with Susan French, director of marketing at HealthLink Inc., about why self-funding may be the answer to your health care concerns.

Mistake 1: Not knowing how much you pay for health care.

Many senior leaders don’t know the itemized cost of health care services used by their employees, even though it’s one of their biggest expenses.

With a fully insured health plan, employers pay a predetermined premium amount to cover medical services for their employees, whether they receive them or not. This leaves most employers without real knowledge of where premiums are being spent. With a self-funded arrangement, employers only pay for the medical services — or claims — that their employees actually receive. Employers who choose to self-fund their employee health plan receive an itemized bill for all the claims incurred by their employees, so they know exactly how much they’re spending and where the money is being spent.

Mistake 2: Believing that health care spending is out of your hands or is just the cost of doing business.

The flexibility that comes with self-funded arrangements makes them ideal for effectively using cost management strategies to save money for the health plan and employees. Employers that self-fund have access to detailed claim and utilization data that they can use to determine where they are incurring the most costs. Employers can sit down with their broker, third party administrator (TPA) or network partner to examine if there is an issue or lack of benefits at the root of high costs.

After there is a solid understanding of where health care dollars are being spent, there is an opportunity to better predict these costs and implement cost containment programs to control health care spending like never before.

While fully insured health plans also feature cost containment strategies, these programs and services remain under the control of the insurance carrier. For some employers, this is ideal. They prefer to take a more hands-off approach by simply paying a monthly premium and letting the carrier take care of the rest.

A self-funded arrangement is more hands-on. Cost containment strategies can be customized specifically to meet the unique needs of the employee group. In the end, the decision of which programs and services to implement, and how to structure the health plan, is up to the employer, not the carrier.

Mistake 3: Being in breach of your fiduciary duty to protect a health plan’s assets.

In a self-funded arrangement, transparency starts with the availability of clinical and financial data that employers can use to uncover utilization trends, high-risk members, inappropriate and/or costly treatments and plan waste. With a self-funded health plan, this data belongs to the employer. They have full access to it and the conclusions that come from it.

In addition, many network providers have developed transparency initiatives designed to help employers and their employees become more educated health care consumers. Tools that help employees look at the costs associated with different procedures and/or facilities, and tools to help employees decide which level of care is appropriate are examples of transparency tools that may be available through different network providers.

Mistake 4: Undervaluing human resources.

An HR department can be an invaluable resource when it comes to selecting and implementing an employee health plan. Often the HR department may have additional insights into the needs of the employee group, which can be useful when determining which benefits should be included in the health plan. The HR department should also be the go-to resource for educating employees and answering questions during open enrollment. Engaging the HR department during the decision-making process and having their buy-in can have a positive impact on the health plan.

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Add maternity management to help cut costs and raise productivity

Integrating a maternity management program into a health plan is a win-win for moms-to-be and employers. Employees and employee spouses who are pregnant or planning to become pregnant can join the program to get the support they need to help them have healthier pregnancies and healthier babies.

“Every pregnancy is unique, that is why maternity management programs offer personalized support from the start of the pregnancy until after the birth of the baby,” says Judy Dawson, HealthLink sales and retention executive. “This support can help keep pregnant employees healthy, reduce their need for unscheduled or emergent care and keep their medical costs down.”

Smart Business spoke with Dawson about the benefits of maternity management.

What are the overall goals of a maternity management program?

The No. 1 goal of a maternity management program is to reduce risks associated with preterm delivery and low birth weight, and encourage employees to be more active in health-related decisions during pregnancy. To achieve this, the program focuses on educating and supporting pregnant employees from prenatal to newborn care.

Employees who enroll are sent educational materials and can receive customized help from nurse care managers so they can understand what is best for them and their babies. They also get access to a 24-hour, toll-free nurse line so they can connect with someone who can answer their questions or direct them to their best option for care.

How does a maternity management program impact employees?

A maternity management program can have a great impact on an employee’s pregnancy and her newborn. Once they join the program, they are assigned a nurse care manager who can provide a number of services, including giving moms-to-be information on healthy eating and exercise, providing education and information on labor options, helping smokers quit, checking for health risks, screening for depression during and after pregnancy, and more.

Every service is focused on healthier moms and healthier babies and can be customized to fit the unique needs of the mom-to-be. The educational materials alone can really impact the decisions a pregnant employee makes during the course of her pregnancy and delivery — and the added support can make a big difference in helping parents-to-be feel prepared and confident as they approach parenthood. For employees who may not have all the support they need at home, a maternity management program can make a huge impact.

What are the benefits to the employer?

Like many supplementary cost-management programs, a maternity management program can help employees achieve optimal health outcomes in a cost-effective and timely manner. This can lower costs for the plan and for the employee. A variety of studies show that maternity management can lower inpatient costs, reduce the number of low-birth-weight babies that require additional care and lower neonatal intensive care unit (NICU) costs by reducing NICU admissions.

In addition to the cost-reduction benefits, offering a maternity management program is a great way to provide additional support to employees as they go through a series of life-changing events. When employees feel supported, it can boost morale and even productivity, and in the case of moms-to-be, it can positively impact their overall health and their transition back into the workforce.

What else should employers know?

Maternity management programs may not be a good fit for all companies. Employers should consider the potential impact offering the program will have on employees before implementing a maternity management program. For example, if a company has a largely older or all-male population, it may not make sense to add the program. Many maternity management programs are purchased on a per employee per month, or PEPM, basis, so it’s important for employers to determine if the outcome is worth the investment.

Employers should talk to their broker or network partner to explore all of their health and wellness and cost management options.


Insights Health Care is brought to you by HealthLink, Inc.