How health benefit plans are evolving to advance whole health

by | Nov 1, 2022

As featured in the Boston Business Journal.

Everyone knows there is a direct correlation between how we treat our bodies and how our bodies treat us. Eating sugary, highly processed foods can lead to health problems like heart disease, diabetes and other complications, for example.

However, much of our health is affected by our circumstances and behaviors. Nonclinical factors like geography, personal finances, access to food and transportation, and social isolation can determine up to 80 percent of health outcomes. Consider the impacts, for instance, of living in a “food desert” with limited access to affordable, nutritious food, or not having reliable transportation to get to doctors’ appointments.

Today, health plans do more than just process medical claims and offer access to providers. They are taking a holistic view of their members’ health, supporting them in many more ways than before by developing solutions to address barriers impeding healthier living, and serving as a connector to health resources and tools that empower people to live healthier lives.

“We need to help individuals live their best lives, and this means supporting their physical, mental and social needs inclusively – not just facilitating medical appointments,” said David Morales, general manager of UniCare, a health benefit organization in Massachusetts that administers health benefits for state and municipal employees and retirees insured through the Group Insurance Commission.

“At UniCare, we are transforming the way members experience health from birth through their retirement years through a unique combination of robust access to providers, personalized care support and powerful digital health tools.”

‘Partner in our members’ health journeys’

A new program that UniCare began offering last year, “Whole Health, Whole You,” provides, in certain plans, care for members who need highly personalized, complex health services. Case managers coordinate care across a team that includes nurses, dietitians, respiratory therapists, pharmacists, exercise physiologists and health coaches.

Members in UniCare’s Medicare Supplement plan have access to a 24/7 nurse line, and all members have access to integrated and collaborative behavioral health care services. UniCare also employs a social worker to connect members to social services and community resources like food or rent assistance.

Dr. Bernard Bettencourt, UniCare’s medical director, says the plan focuses on ensuring members understand their benefits and the importance of accessing care in the right setting and at the right time to encourage the best possible health outcomes.

“We are a partner in our members’ health journeys. When we focus on bringing the right care to our members, it not only helps keep overall costs affordable, it helps avoid unnecessary hospital stays and ultimately improves health outcomes,” said Bettencourt.

He cites examples like encouraging members to go to their primary care provider for minor ailments or routine care instead of to the emergency room, and educating them about the importance of getting medications filled and taking them as prescribed to reduce the likelihood of a condition getting worse.

Part of health plans’ initiative to make care more accessible and personal includes introducing virtual care options. Two years after the pandemic, today many consumers are more comfortable accessing care and chatting with their health care providers virtually. Health plans are embracing these changes by making it easier for members to be more proactive in managing their health and wellness online through digital tools like telehealth and virtual care apps.

“For our members who want a convenient option to access care when they want it, digital tools like our Sydney Health mobile app offer personalized physical and mental health resources and access to telehealth services in the palm of their hand,” said Morales.

As the health care industry continues to evolve, health plans are stepping up to support a preventative, whole-health approach that enables their members to live healthier lives.