The Employee-Centered Health Plan

The model for this employee-centered plan was based on best practices derived from the company’s innovative Medicaid plan. In addition, MHP addressed a key industry-wide issue faced by consumers of health benefit plans: difficulty making informed healthcare decisions due to lack of credible information. According to the December 2005 Employee Benefit Research Institute and Commonwealth Fund Consumerism in Health Care Survey, few health plans of any type provide cost and quality information to help people make informed decisions about their healthcare. The study also found very low levels of trust in the information provided by health plans. (1)

First, MHP addressed the issues of credibility and trust by assigning specific registered nurse case managers to each employer. MHP found that its Medicaid clients trusted health information provided by case managers. Similarly, in the MHP commercial plan, RN case managers work directly with employees to support their care plans, and are instrumental in facilitating patient care with physicians. Guidance with health plan rules, providing general health information, and assisting with cost-effective and in-network services all help employees maneuver through the complexities of the healthcare system, and keep health services costs in check.

Second, MHP focused on information and education in its employee-centered approach. Beyond the industry standards of offering quality provider and medical information, and special communication for those with chronic health conditions, MHP focuses on education and personal management of healthcare. Employees need to understand the importance of managing their health and the critical role their primary care physician plays in the quality—and cost—of their care. Research from the MHP Medicaid program showed a correlation between patient visits to primary care physicians and decreased nonemergency utilization of emergency room or urgent care facilities. The cost savings in visiting a trusted primary care physician instead of the emergency room is astounding and another important way to contain healthcare costs.

The RN case managers act as facilitators of information and health education providers. In addition to helping employees manage their care plans, RNs periodically visit the workplace for Lunch & Learn talks on healthcare topics. For after-hours questions, a nurse is available to provide employees with easy, 24-hour access to health information.

Preemptive intervention is another initiative of the employee-centered plan that also was a best practice of the MHP Medicaid program. Employees are screened and are encouraged to visit their healthcare provider within 60 days of beginning the plan. This tactic had proved effective with MHP Medicaid patients in managing and delaying the onset of common, but costly chronic conditions, like diabetes and heart disease. Often Medicaid clients would be surprised to learn they were borderline for certain health conditions, but the screenings allowed them to take action with diet and lifestyle changes to maintain their health.

The next time you hear the phrase “consumer-driven health plans,” consider the concept of an employee-centered approach to your company’s health plan. Employees who are engaged in their healthcare management are assets to business. Reduced absenteeism and healthcare cost containment are just two of the benefits. Keeping your employees and their health needs at the center of your plan can help your workforce stay healthy and productive.

Bethany Caughlin, RN is vice president of medical management for McLaren Health Plan.








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