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Why does a 'health' organization
pay so much attention to illness?
09/12/04
Blue Care
Network has programs for members with diabetes, migraines,
congestive heart failure, asthma, depression, cardiovascular
disease and more than a dozen other chronic conditions. If
you're among the fortunate who have escaped these all-too-common
conditions, you may wonder why a health maintenance organization
- which after all has "health" in its name - would pay so
much attention to illness.
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It's about helping people reach their best level of wellness.
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It's about helping you - the company that's paying the cost
of coverage - keep your premiums affordable.
"When
members really take control, they feel better. No one wants
to spend time in the hospital. No one wants to feel sick.
Our programs simply give people the information and resources
to feel as good as they can," said Janie Flemming, vice president,
Quality Improvement.
Our
programs reduce the number of inpatient hospital stays, With
the cost of the hospital care alone - not including specialists
and other costs - averaging $7,000 a stay, the costs avoided
add up fast.
That's
why we automatically enroll members with these conditions
in our programs. We identify them through their prescription
drug and medical claims. We help them achieve more control
over their illness through regular mailings of educational
materials, postcards reminding them to get important health
screens, phone calls and other interventions. We encourage
them to use their benefits to get the tests, treatments and
equipment they need.
While
it may seem counterintuitive to push members to use more medical
services, it can actually save money in the long run. Not
only do members not use costlier medical care, they're more
productive in their home and work lives. For instance, people
who receive active diabetes treatment are more productive
at work, have higher retention and miss less work, according
to studies cited by the National Committee for Quality Assurance.
NCQA
accredits health plans, setting standards and measuring plan
performance. Blue Care Network has achieved excellent accreditation
six times in a row. BCN was also the first commercial plan
in the country to receive full patient and practitioner accreditation
for its disease management programs in asthma, congestive
heart disease and diabetes.
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