Chamber Series Part 4 | How You Can Support Your Team with the Rise of Health Care Costs: Care Management Support For Members With Complex Conditions

Chamber Series | Part 4 of 6

We’re back with Part 4 of our high-quality care and cost savings series. | View Part 1 to learn more about pharmacy saving programs. | View Part 2 to learn more about medical cost savings programs. | View Part 3 to learn what you need to know about premium rates. 

As a recap, we know the upward trend of health care costs is expected to continue, impacting employers and individuals alike. High drug prices, increases in outpatient procedures, and more members needing high-cost hospital care are challenging health plans, employers, patients, and the entire health care system.  

So how can you make sure your employees are being taken care of, and what is Excellus BCBS doing to help improve quality of care while combating these costs?

Care management support to members with complex conditions and high medical bills

In the fourth part of our series, we’re going to focus in on how we’re supporting members with high-cost conditions. We have found that more of our members are receiving care for severe and high-cost conditions that add up to more than $100,000. 

A relatively small number of members – only about 1% –often drive a large majority of a plan’s health care costs. These are usually members with chronic or complex conditions, and oftentimes they are managing multiple health concerns at once. 

Once an individual with a high-cost condition has been identified, the next critical piece is to ensure that support is being tailored to their unique needs. At Excellus BCBS we have care management teams that include specialists like registered nurses, dietitians, behavioral health specialists, and social workers, who are available for all members who want help managing their care or just staying healthy. Those with chronic conditions typically benefit the most from our care management teams to ensure they have the full range of care and support required to manage their conditions. Our care management teams can help members in a variety of different ways:

• Customize an outreach and engagement plan for members.
• Educate them on the importance of following their doctor’s care plan and help them adhere to it by encouraging follow-ups with their specialists.
• Assist members with interpreting their benefit package and claims history to identify potential solutions or ways to maintain their health and control costs.

Actions you can take to help control costs:

1. Download the High-Cost Claimant and Care Management Toolkit where you can access more information, resources, and a prewritten email for sharing with your employees. This toolkit will support you in opening a dialogue with employees as well as sharing ways employees can navigate the health care system, understanding what care is right for them, and help improve outcomes.
2. Please don’t hesitate to contact your account manager or broker for more information on these programs.
3. For more helpful content to educate and engage your employees in their health care, visit ExcellusForBusiness.com.

Prevention is key when it comes to health care. Next week we’ll dive into the importance of preventive care programs.

Next in the series, we’ll dive into the importance of preventive care programs.