How care management helped a health plan tackle high costs

A care management program combined with better plan design can help health plans slow down high-cost trends among their members, according to a new white paper.

It describes how New York-based Montefiore Health System made changes to its plan design and its care guidance system to cut its per-employee per-year health plan expenses and utilization, which were above average for New York hospitals. The employee health plan, which is self-insured and covers 20,000 employees and their dependents, worked with Cammack Health, a New York consulting company, to create the Montefiore Employee Care Guidance program.

Through the care guidance program, the health system educated and encouraged health plan members to make healthy choices, helped those with significant health issues to navigate the healthcare system, identified members at risk of health problems and guided them to wellness programs, and reduced costs by improving health trends and encouraging members to seek care within the Montefiore system, the white paper says.

As a result of the program, per-employee per-year costs were cut from $14,899 in 2012 to $13,853 in 2014. Claims costs were reduced by 10.8 percent, with reductions in inpatient admissions (19.6 percent), non-maternity-related inpatient admissions (26.7 percent) and reductions in emergency department visits (13.4 percent).

The care guidance program is a voluntary, opt-in program available to all members covered by the Montefiore health plan, and participants work closely with a personal health nurse mostly via the telephone but with some on-site services. 

 "We understood some people might view this kind of program cynically, as simply a means of managing claims. But it's not being done by the claims administrator; it's being done by a separate entity," William Shanahan, former vice president of human resources at Montefiore, says in an announcement. "This, plus the fact that the program is voluntary, sends a clear message to employees that the program is here to help you and your dependents, not to mandate you to do anything. From what we've heard anecdotally, this approach has worked to reassure people."

Cammack Health had similar results when it worked with Southcoast Health, a system in Massachusetts and Rhode Island, which successfully overhauled its costly employee health plan. Wellness initiatives also made a difference in savings for the North Carolina State Health Plan, which covers teachers and state employees.

To learn more:
- read the white paper
- here's the announcement

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