The health insurance benefit you may be overlooking

Free one-on-one care coordination programs range from healthy-living assists to managing complex medical conditions

Woman talking on phone in her home

Image caption: Your care manager will work with you to help you understand and manage your condition

Image credit: GETTY IMAGES

After Patricia Garmon was injured in a car accident in 2010, her recovery was long-term and multifaceted, including multiple rounds of steroid injections and physical therapy. Not long after she began the healing process, Garmon&em;who works as a benefits service representative at the Johns Hopkins University Benefits Service Center&em;was contacted by her insurer, CareFirst BlueCross BlueShield.

"Based on the claims, they could identify something was going on, so they reached out asking if I could provide more detail," Garmon recalls. With her permission, CareFirst enrolled Garmon in its voluntary Complex Care Coordination program. "They had a registered nurse call me and talk to me about how my progress was and answer any questions I had about the treatment. They followed me through the whole [recovery] process."

Care coordination such as that received by Garmon, also called care management, is a complimentary service offered to employees and staff through their insurers, including CareFirst, Johns Hopkins Employer Health Programs (EHP), and Kaiser Permanente. A completely voluntary program, it's one of many often-overlooked benefits included in health care coverage. Members often don't realize the benefit exists until they're contacted by their insurance providers based on recent claims. "Navigating the many resources available can sometimes be a little overwhelming if you don't know where to go," Garmon adds.

In addition to helping those recovering from serious injuries, insurers aim to assist members with complex medical conditions—such as diabetes, high blood pressure, asthma, chronic obstructive pulmonary disease, and congestive heart failure—with help from a care manager.

Darlene Kurek, a benefits consultant at JHU's Benefits Service Center, says that the program is "generally a way of providing support and services to help the member better understand and better manage their condition."

The program, she says, "coordinates care among all treating providers, with the outcome, hopefully, of a better quality of care for the participant. It's also a way to control health care costs, but the primary reason for a care management program is better health outcomes for the patient."

EHP's care management program, for instance, includes three tiers to best assist members depending on the seriousness of their medical diagnoses, from managing complex or multiple medical conditions to providing education about less-serious conditions for maintaining a healthy lifestyle. (Changes to EHP's benefits are coming in July, so if this is your insurer, be sure to check with the company directly for the most up-to-date information.)

Kaiser Permanente offers similar services through its Complex Chronic Conditions Case Management and Wellness Coaching by Phone programs, and CareFirst through its Total Care and Cost Improvement program. In some cases, such as with CareFirst's cost-share waiver, the programs may help members handle the financial burden of their conditions as well.

"With many of these diagnoses, you need multiple treatments, which can cost a lot of money even with insurance," Kurek says. "So if you meet certain criteria, the member may also be eligible for a cost-share waiver, where things like a co-pay, co-insurance, or a deductible would be waived. They don't want cost to prevent someone from following their care plan. The incentive of a cost-share waiver is something that employees might not be aware of."

Garmon says that, for her, the biggest benefit in participating in the program was having a single point of contact for any questions or concerns throughout her recovery process. "You're assigned to that case manager, and you can call and say, Hey, I'm feeling this way. Would you recommend I call my doctor? So that was nice to have."

Garmon points out that there are many resources available through employees' benefits packages that go above and beyond standard health care services, and she encourages all employees to seek them out. "Go onto [your insurance provider's] website and look to see what is available to you. There are a ton of wellness and health benefits that these insurance carriers offer," she says. "If you have any questions about what's covered as an employee here, always call [your provider], and they will tell you whether it's a covered benefit or not."

In addition to insurer benefits, Johns Hopkins offers its own program for employees affected by cancer. Launched in January 2015, Managing Cancer at Work is a complimentary part of the employee benefits package for those who want to be proactive in preventing cancer as well as for those with a cancer diagnosis or who are caring for a family member with cancer. The program offers support through web-based education and resources, one-on-one counseling with a nurse navigator, and support groups. To learn more, visit the program website.

"I think care management is a really nice benefit for people who do need one-on-one nursing, especially for employees who have cancer or other complex diseases and they've got to work while undergoing treatment," Garmon says. "I think it's an invaluable benefit to them."

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