The World Health Organization has deemed 2020 "The Year of the Nurse." Yet, in the United States, the healthcare system is often terrifying, expensive, disjointed, flawed and sometimes deadly. And it’s often expected people navigate this confusing system alone. Today, healthcare management is shifting toward a comprehensive care coordination. Why? Because it can serve as the centralized hub that manages all the spokes of healthcare within an employer health plan, and the best ones are anchored by nurses.
For 40 years, 88% of spending has gone to what drives just 20% of outcomes stealing from what drives 80% of outcomes – CEO’s Guide to Restoring the American Dream by Dave Chase
Care Coordination is Concierge Care
True care coordination is designed to move away from the blanket total wellness programs employers have come to rely on, instead building a customizable and individualized approach from a clinical perspective to pinpoint solutions that improve lives and the bottom line. It should center around nurse advocacy - giving employees access to a clinician who can help them at every step of their health journey. Think of it as an employee benefits concierge model, with the team designed to meet the goals of both the employer and the employee.
At best, the model is built to protect each person by providing personalized health literacy and steerage to quality providers for the best outcome while protecting an employer's bottom line. For benefits advisors, it allows the offering of a fully integrated platform including everything from plan member services, steerage to appropriate care, utilization management, individual case & chronic disease management, specialty pharmacy advocacy and individual health plan management. When the nurse advocates you deploy have access to the data surrounding a plan, they can work to achieve the goals you've already lined up for your client.
Did you know?
- 6% of enrollees spend 80% of plan dollars
- 20% are misdiagnosed
- 40% have wrong or suboptimal treatment plans
We believe second opinions matter. “The biggest quality issue is the least managed – the appropriateness of care,” – Tom Emerick
As an advisor or an employer who is working to develop a high performing health plan, care coordination teams work in conjunction with your innovative decisions and look for red flags in the plan while being proactive in their approach and not reactive. One example of this would be a recent experience working with an advisor who recently scrapped an ineffective wellness program and implemented our proactive care coordination model that included a total wellbeing health index, a transparent PBM, and an independent TPA. So for those working to buck the status quo, care coordination is the way to go.