Broadening the
Physician’s Perspective
of Health Insurance

"Our aim is to facilitate the
physician's care by educating
and supporting our members."
-Steven Bishop

When physicians think of health insurance, chances are they think of coding, formularies and preauthorization lists. Historically, insurance interactions were mostly transactional. But the industry is working hard to broaden the physician’s perspective of us. In the future, we would like to be known as much for our clinical resources as a claims payer.

Beyond claims payment, we are stakeholders in our members’ health and well being. Our aim is to facilitate the physician’s care by educating and supporting our members.

That is the principle behind the latest generation of resources being offered by insurance companies all across the country, including everything from wellness incentives to chronic care management programs. For the rest of this column, I will describe some of these programs and how they support physicians.

I am most familiar with Humana’s programs and admittedly biased in their favor. Many other insurers offer similar programs. Programs vary by plan type, but are almost always free to the member. Some of my favorites are as follows:

• A payer-sourced electronic health record – Humana will launch the Availity Care Profile (ACP) in Texas by the end of the year. This tool provides participating doctors with a consolidated view of their patients’ health care across all physicians and providers, which helps improve patient safety, eliminate duplicate medical procedures and reduce the time your staff spends in assembling a patient’s information prior to his or her visit.

• Wellness – Insurers emphasize wellness through a variety of programs, including some that offer their members prizes for exercising. Addition-ally, we support expectant mothers through educational programs that help them stay healthy and be better informed at office visits.

• Health coaching – Imagine how much more successful your patients could be in reaching their goals if they had someone cheering them along. Many people have just this kind of support available through health coaching programs. Health coaches can support your instructions by encouraging members to exercise, stop smoking, lose weight, relax, eat better or take better care of their backs between visits. Early studies have shown tremendous results.

• Integrated medical and behavioral health programs – According to the U.S. Department of Health and Human Services (DHHS), 40 percent of people with common medical conditions such as hypertension, heart disease, diabetes and cancer, have a mental health or substance abuse problem. Insurers like Humana are integrating these programs for a “total person” approach that addresses root behaviors that lead to poor overall health.

• Chronic care management programs – Programs for people with such chronic conditions as diabetes, heart failure, coronary artery disease and chronic kidney disease are nothing new. However, these programs have become much more member-centered. Most emphasize positive behaviors and provide advice on managing side effects and avoiding triggers.

• Medication guidance and adherence – Various tools help patients follow your prescription instructions. Most tools double-check for harmful drug interactions. Others recommend lower-cost alternatives. Members are more likely to follow your instructions when they can afford their medication. This is particularly true of Medicare beneficiaries as they negotiate the “coverage gap” during which prescription drugs are not covered.

As these programs evolve and others emerge, we see a future where we are more than just a claims player. For example, Humana is already piloting a program that provides weight loss tips to members over their cell phone or personal digital assistant. We hope you will look to these programs as ways to complement your efforts.

Steven Bishop is Vice President of Network Management for Humana’s South Texas Region. He also represents Humana in the BCMS Circle of Friends and as a board member of the BCMS Foundation.