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eQHealth Blog

Why Every Self-Insured Employer Health Plan Should Include Medical Management

Healthcare and health insurance have always been challenging for employees to understand and manage. The complexities of the healthcare system almost seem purposely designed to generate confusion and frustration.

But in today’s world, where the growth of high-deductible health plans often means out-of-pocket costs for employees ranging in the thousands of dollars per year, there is more urgency than ever to reduce unnecessary spending on healthcare. Especially since 40% of Americans say they would struggle to cover an unexpected cost of $400. Yet it’s easier said than done, as many employers – and employees – have discovered.

Major distraction

The problem is, attempting to manage the quality and cost of care for themselves and their families can become a major distraction for employees at work if they must do it on their own. They may need to call providers or health insurers to obtain information, arrange appointments, follow up on questions about an invoice, etc. Typically, they must do this during “normal business hours,” which means they’re not focused on their work.

Even if they’re not actively pursuing contact with providers or insurers, nagging questions or uncertainties about their own or their family’s health may be on their minds, distracting them from what their employers are paying them to do. That’s just human nature. So is worrying about how to pay for care that has already been received – or that they know is still to come.

The results of this stress can vary. In some cases, it might be a reduction in productivity. In others it could be an increase in absenteeism. Costly mistakes can occur, customer service can suffer, deadlines can be missed – the list goes on.

The bottom line is that the more employees are distracted by concerns about care (or costs), the worse it is for them – and for the business. And given that the yearly cost of employer-sponsored health benefits is nearly $15,000 per employee – making it one of a business’ largest expenses – leaving it up to employees to navigate that byzantine system is like taking off in a $120 million jet without a flight plan. Or even a compass. It just isn’t smart business.

Giving employees guidance

This is where investing in medical management services can be a huge difference-maker for self-insured employers. Rather than leaving employees on their own to determine where they should go for care, what all the charges on an explanation of benefits (EOB) are, and overcome other complex challenges, adding medical management services to a health plan can take that burden off employees’ minds.

For example, an employee may be told he/she needs an MRI. What that employee may not realize, however, is there can be a huge cost difference between receiving that MRI at a hospital versus an off-site clinic or specialty laboratory, and staying in-network rather than going outside the network. A care navigator can help with all of that, which means the only decision the employee must make is when to schedule it.

Medical management services can also help employees with the transition from the hospital to home after discharge to ensure the employee is following the plan of care to help reduce the likelihood of an unplanned readmission. Services such as medication reconciliation to avoid issues such as adverse drug interactions, educating patients to manage their own self-care (or care for a loved one such as a child), coordinating access to primary care or social services where needed and other services can help employees or their family members recover quickly and completely so employees can get back on the job.

Employees with one of more chronic conditions can similarly benefit. A chronic condition management program can help them learn to manage their conditions more effectively by following plan of care details (such as employees with severe hypertension taking blood pressure readings each day), coordinate data between providers (particularly valuable when co-morbid conditions are present and multiple specialties are involved), coordinate with community-based organizations to address social needs (access to food or transportation, dealing with loneliness, challenges with taking medications) and manage other issues.

By making these services available, employees are empowered to receive the best care available while understanding and minimizing their costs. The services also help employers and employees eliminate duplicate or unnecessary care (and the costs associated with it) by delivering a holistic look at all care being provided.

Giving employees the help they need to make their way through the complex healthcare system, both clinically and financially, means employers can relieve the stress that causes distraction, missed days and lost productivity. The result is employees who are more present and focused on the job and happier with their employers, which helps with retention. All while driving a healthier bottom line for the business.

In the end, it’s a win for everyone.

How familiar are you with medical management services? Have you ever used or considered adding them to your health plan? If you have used them what have your results been? eQHealth is here to help navigate you and your members through the healthcare continuum. 

Click here for more information on how eQHealth can help. 

Have any questions? Call us toll-free.1-800-720-2578