One of the continuous complaints made by consumers, employers, doctors, vendors and advisers alike is that the choice, cost and understanding of today’s benefits are too complicated and that more simplicity and education are required of the healthcare system.

Jeff Spahr, vice president of specialty business at Anthem, points out the need for integrated healthcare and how having an all-in-one program could reduce healthcare costs, increase care efficiency and make the benefits enrollment process easier.

Bloomberg/file photo

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“The treatment of and preventive care for costly chronic diseases are better and more dependable than ever before,” Spahr says. “When it comes to the delivery of healthcare, we are many hands working to achieve the goal of more effective, realistically priced care. We can achieve this by bringing together providers, insurers and patients in a new approach to care.”

Dr. Nick Gettas, national medical officer for Cigna, says he and Cigna are no strangers to integrated healthcare and have been working toward complete actualization of integrated healthcare for a long time.

“[Integrated healthcare] is something we have tried to make sure that our clients understand, which is the value of aligning and integrating all the clinical issues together holistically as a benefits offering for the positive results that it has on the outcomes in clinical care, both from the perspectives of the patients experiencing the care and for the doctor or healthcare professional being able to render care seamlessly and timely and getting a better outcome overall,” Gettas says.

Real-life integration
Spahr says while Anthem has received a lot of interest from employers on integrated healthcare, advisers and brokers have been the quickest to approach Anthem with questions on how to better understand the functionality of integration.

“[Brokers and consultants] are just now starting to see the value in [integrated healthcare], so we are getting a lot more questions, but there still is a fair amount of work,” Spahr says. “The industry has been separated into vision, dental, life and disability for a really long time and there hasn’t been a lot of change or anything exciting so we’re seeing that it takes a little bit of time for brokers and consultants to wrap their heads around this.”

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Spahr added that advisers are also trying to understand how to change their approach when they go out to find a new benefit program for their clients.

Both Spahr and Gettas say when it comes to advisers understanding how integrated healthcare can work for their clients; these are some of the necessary questions they need to be asking:

  • How do I identify high risk individuals? Many dental carriers, for example, offer additional dental cleanings if someone has a high risk for a condition like diabetes. The difficult question to askis how do you know if someone is diabetic? This is where many standalone carriers will fall apart because they cannot determine who is diabetic. Integrated healthcare, by contrast, can be applied in a measurable way.
  • How do I communicate my program to employers and individuals? Using the same dental example, a dental carrier may have a great program that nobody knows about and employers may not be educating their employees on what is the right program for them to enroll in. From the integrated healthcare perspective, providers will already know who is diabetic and who might be high risk because the medical information will be readily available, rather than the patient having to explain their conditions to multiple providers.
  • How do I share clinical and health information back with someone’s medical carrier? If an eye care professional finds someone who is diabetic and the conversation only exists between the doctor and the patient, there is less of a chance the patient will act on the diagnosis they have been provided in a timely manner. Through analytics, integrated healthcare can track the progress of the patient and can be monitored between visits to a primary care physician, vision care expert and dental professional to ensure treatment is being provided quickly.
  • Does your company have in-house capability and can you offer area of expertise for my clients? When advisers and brokers approach a vendor on what they have to offer for their clients, they need to know how much that vendor can offer alone or if they are partnered with other vendors to offer expertise to supplement additional programs.

“At Cigna, we are our own PBM. We don’t call it a PBM because it can offer standalone PBM services, but it is an integrated offering together with medical when appropriate,” Gettas says. “We actually have our own disability unit and behavioral unit, so we don’t have to go to [another vendor] to try and integrate and align.”

Other questions Gettas says advisers need to be asking when searching for integrated healthcare providers for their clients are:

  • How are your processes different?
  • How do you modify your benefits?
  • How does the communication work between different components?
  • Are you getting a credit through the price charge either to the end point consumer or to the client?
  • How do you give back to the client?


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