The healthcare delivery process has traditionally been fragmented and confusing for consumers. While evaluations, specialty care, drug delivery and rehabilitation are rightly handled by different practitioners, there’s rarely meaningful coordination between the individual components.
Care Coordination is coming. As patient advocacy increases and people begin to consider themselves consumers of healthcare products, care coordination and navigation is becoming an essential component to healthcare plans. The care coordination model keeps stakeholders informed and ensures the delivery of the best possible care for the patient. More specifically, with care coordination, all healthcare providers working with a particular patient share important clinical information and have clear, shared expectations about their roles.
But how does this work in practice? Let’s take a closer look at care coordination and navigation and how it’s poised to reshape the healthcare landscape.
CARE COORDINATORS ARE ESSENTIAL
The primary point of contact in the care coordination model is the care coordinator, who advocates for plan participants and helps navigate the healthcare landscape. Care coordinators provide a trusted and knowledgeable resource to guide participants through the often confusing process of getting the best healthcare services.
Coordinators answer questions about benefits, claims and healthcare services, and proactively connect plan participants with the best practitioners. For example, if a patient breaks a leg and needs to see an orthopedic doctor, the care coordinator can help track down the closest doctor who has the soonest availability and also provides on-site physical therapy. The care coordinator can also make sure any x-rays or MRIs are delivered to the doctor to avoid duplicate, costly and often painful tests.
Throughout the patient-doctor relationship, coordinators proactively intercept redundant, delayed or questionable treatment to help plan participants, their families, and their physicians work together to ensure proper care and improve employee wellness. In time, care coordinators increase efficiency and reduce costs for plan participants and providers.
THE TRADITIONAL CALL CENTER MODEL IS BROKEN
The traditional healthcare call center doesn’t work for patients. It approaches patient care from a reactive stance rather than proactively making people feel cared for and nurtured. In addition, in the current fee-for-service model, doctors get paid for each appointment — not necessarily for the quality of care they provide.
While this reactive approach may have worked in the past, people now have access to more information than ever before and expect guidance beyond what they can find in a Google search. They are more willing to second-guess “doctor’s orders” and make their feelings known about experiences. A proactive approach to patient care is the only way to gain trust and encourage engagement in a healthcare program.
Care coordination and navigation changes the traditional reputation of health insurance being an unfriendly and unaccommodating industry. It reworks the member experience to meet members when and where they need help making healthcare more efficient for plan participants. By offering a central call center with dedicated care coordinators, members experience a white glove approach to all of their healthcare needs, taking a global problem and resolving it one amazing experience at a time.
With the care coordination and navigation model, members spend an average of 7 minutes on the phone with a care coordinator versus a 1 minute average seen in traditional call centers. In addition, approximately 34% of calls are outbound as care coordinators proactively reach out to members, helping them prioritize care, engage in preventative treatments, and look out for potential red flags.
HEALTHCARE INSURANCE COSTS MUST BE REDUCED
It’s no secret that the rising costs of healthcare continually adds stress to CEOs, HR professionals and employees. While uncertainty will always exist over decisions made in Washington on healthcare rules and regulations, we can take control over rising costs through the care coordination and navigation model.
Care Coordination reduces healthcare in two ways.
It makes healthcare more efficient by coordinating care for plan participants.
It reduces the amount of services members use in the future by actively helping them become healthier over time.
In fact, care coordination and navigation reduces wasteful spending and can cut healthcare costs by 7-8% without cutting benefits. Care coordinators facilitate this savings by intercepting treatment and claims in real-time and eliminating any redundant or unnecessary services.
The fight against redundancy doesn’t just reduce costs, it reduces the stress associated visits to the doctor and builds trust in the healthcare system. As care coordinators prioritize the plan participant’s best interests, money is saved on readmissions, hospital stays and emergency room visits - all impacting the bottom-line.
HOW CAN YOU DELIVER COORDINATED CARE?
If you recognize inefficiencies in your current healthcare program, it might be time to consider working with a program provider that understands care coordination -- and has the results to back it up.
Companies with over 100 employee lives can hire a partner organization like Apta Health to manage the care delivery process and help employees navigate the healthcare system. At the same time, your business benefits from eliminating waste, reducing overhead and avoiding unnecessary extra costs typically associated with delivering healthcare to employees.
Apta Health empowers employers to get the most out of their health benefit plans. Our extraordinary program combines the best solutions in the industry with cutting edge technology to reduce wasteful spending and drastically bend the trend of rising healthcare costs.
Care coordination and navigation is at the heart of this program. Through care coordination we prioritize independence, transparency and expertise. Contact us to discuss how to proactively manage your group health plan and reduce wasteful spending.