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Focus on Health Plans
QualCare is the largest provider-sponsored managed-care organization owned and operated in New Jersey, with more than 600,000 members enrolled in a range of health plans and other services. With an innovative outlook, QualCare is a regional plan that is competing successfully with large national carriers.
We talked to Allison Hofman, QualCare vice president of sales and marketing, about the key health and wellness issues currently facing health plans and their members. Her responses provide a blueprint for health plan best practices.
Regional health plan competes with national carriers
In order to stay competitive, QualCare needs to provide clear value for its client companies and its members. Five years ago, the company saw the direction large plans were moving and made the investment to offer clients integrated online health management programs. "We're always watching for what's coming next and what would be indispensable for our clients' wellness strategies to be successful," said Hofman.
We're always watching for what's coming next and what would be indispensable for our clients' wellness strategies to be successful.
QualCare offers the WebMD MyHealth Manager platform to help clients enhance their programs and improve their employees' health. QualCare has also found that MyHealth Manager takes engagement with members to a whole new level.
Best practices in health plan-client integration
QualCare starts each engagement by sitting down with the client to discuss its health management goals. Nearly every client is concerned with health costs, including absenteeism. The ability to customize the platform, integrate other programs, and create a unique experience for members is especially important for these companies. A client can buy a suite of disease management programs, for instance, and integrate them into MyHealth Manager and then promote them in tandem. "We see this as a value-based benefit design that helps eliminate barriers to wellness and preventive care," said Hofman.
We see this as a value-based benefit design that helps
eliminate barriers to wellness and preventive care.
Another aspect of integration revolves around the personal health record (PHR). While health plans have historically provided tools for members to check the status of claims, until recently it was uncommon for members to see health information in an organized, user-friendly, and understandable way. The WebMD Health RecordSM gives members a central repository to look at their health, their activities, and their claims, including prescription data. And clients love the integration of the health risk assessment and each individual's personal health record for the way it powers population health management.
Many clients struggle with how to explain the benefits of staying in-network. "We don't have a lot of clients who have embraced consumer-driven health plans, but transparency is the way the market is going. The MyHealth Manager products we offer allow members to look up quality data and compare in and out-of-network costs," Hofman added.
Communication and rewards programs engage members
QualCare also works closely with clients' marketing departments to make it easier for them to communicate to their employees about their health and benefits. The company provides a media kit for clients with monthly articles that employers can use in their newsletters. Other materials help companies communicate about important health tools and health management programs. These materials allow for individual client branding so each company can customize them for their population's risks and culture. "Clients are becoming creative on how to increase enrollment," said Hofman, "and all our clients realize they have to reward people."
Transparency is the way the market is going. The MyHealth Manager products we offer allow members to look up quality data and compare in and out-of-network costs.
Next steps in best practices
QualCare continues to watch for what's next in order to stay competitive. Upcoming steps under consideration include:
- New ways to reward members. To reach the highest levels of utilization, QualCare is looking at rewarding members for offline activities, such as using a fitness center, as well as for claims activity, such as imported claims data showing that a member had a screening mammogram.
- Increased integration. Adding imported lab values and results to the current self-reported, medical claims, and prescription information will create an even more comprehensive PHR.
- Portability of personal health records. Members and clients reap the benefit of giving individuals access to a lifelong personal health history.
- Access to online health programs. QualCare is talking to clients about making investments in kiosks, and is excited that some clients are working right out of the gate, offering health fairs with kiosks, gifts, and raffles to encourage full participation.
- Build provider support. Through articles and face-to-face meetings, QualCare is educating providers on the value of working with and supporting their patients' personal health record.
By applying best practices, QualCare is dedicated to delivering a single source for members' health information, providing deep integration for clients, and generally being indispensable to their wellness strategies.
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