This article is third in our series examining how the self-insured industry can respond to the long-term effects of COVID-19 on member health.

The COVID-19 pandemic has impacted almost every part of our daily lives, including physical, financial and emotional health. As the pandemic continues to worsen, we are gaining greater visibility into emerging mental health issues among the U.S. population. Consider these recent statistics:

• According to a Kaiser Family Foundation (KFF) health tracking poll in July, 53 percent of U.S. adults say COVID-related stress has negatively affected their mental health – up from 39 percent in May.
• Census Bureau surveys have found up to 40 percent of U.S. adults struggling with anxiety, depressive disorder or substance abuse since the pandemic hit.
• More than half of behavioral health organizations are seeing higher demand for services, according to the National Council for Behavioral Health – but capacity is diminishing.
• In addition, KFF found most U.S. adults think the worst of the pandemic is yet to come.

Mental health claims within our ecosystem are significantly on the rise, and clients are reporting increased concern about pandemic-related effects on their employees – adding new life to discussion about modifying care delivery models. The healthcare industry is acknowledging the significant correlations between physical and mental health, traditionally cared for as separate conditions. Integrated care solutions that treat the whole person could deliver improved outcomes with less expense.

To that end, in the face of continuing upheaval and stress from COVID-19, what resources can self-insured employers offer to support their employees? Here are four solutions to consider:

1: Use data to identify members at risk.

Employers are increasingly turning to data to identify employees at risk and proactively offering them the resources they need. Today’s technologies are providing new insights by leveraging real world data (RWD), which refers to health-related information collected and reported by diverse sources on patient health status, population trends and the routine delivery of care.

Within an ecosystem like ours, RWD come from multiple sources including electronic medical and health records, claims and case management databases – even from employees themselves. We anticipate self-assessments, social media and health-related wearables as emerging data sources that will soon be added into the mix to more precisely predict those in need of behavioral health services.

2: Offer a care management program with personalized support and navigation.

Poor mental health and behavioral choices make physical health and chronic care conditions more challenging and expensive to manage. To meet the patient’s physical and mental health needs, comprehensive care management involves the active monitoring of behavioral health to help prevent serious health events and navigate care across multiple providers and settings.

A full-service care management program with a nurse navigator as a central point of contact can personalize its services for employees who may benefit from more comprehensive attention. As they coordinate care and guide patients to an individualized treatment plan for better behavioral health, nurse case managers can help relieve anxiety and make at-risk patients feel more in control and proactively managing their health.

3: Ensure networks provide access to mental health services with telehealth options.

Demand for behavioral health services is expected to stay high for the foreseeable future. According to the National Alliance on Mental Illness (NAMI), however, many people do not have the same access to mental health specialists as they do for other medical providers – nor do they have as many available options. When they can find a mental health professional, they may be forced to go out of network to receive treatment.

This leads to higher out-of-pocket costs for mental health care compared with other types of primary or specialty care. When people face increased expenses, it may lead to seeking less care — or going without any care at all. Access to mental health services, clearly communicated to employees, is key to seeking and receiving treatment, which in turn improves productivity and retention.

A coordinated care team is better able to meet both the mental and physical health needs of the patient with improved outcomes.  Along those lines, the American Medical Association has established the Behavioral Health Integration (BHI) Collaborative with seven other physician associations to promote the integration of behavioral and mental health care into primary care practices. Such steps are critical for greater access and a robust telemedicine plan that addresses the issue of fewer available mental health providers by incorporating primary care into the solution.

4: Include an Employee Assistance Program in your benefits package.

People are struggling more than ever in the wake of COVID-19. An Employee Assistance Program (EAP) provides confidential support for numerous concerns, including mental health issues and personal, family or work problems. Counselors and other specialists can assist with stress, depression, substance abuse or financial issues. Identify an EAP that responds quickly when employees reach out.

The benefits of an EAP make such a program a worthy investment. NAMI estimates that untreated mental illness costs the United States up to $193 billion annually in lost productivity.

When employees are able to successfully manage their health, employers can expect to see improved job performance, productivity, engagement and retention; while minimizing the impact to their bottom line due to turnover, absenteeism, increased mental health services and higher insurance costs.

Data-driven solutions

The COVID-19 pandemic has forced all of us to find new solutions for improved health and access to the right care delivery. Through the mental, physical and financial implications of this global health crisis, Valenz remains committed to delivering on our core promise of smarter, better, faster healthcare – so our clients and their employees are strong, vigorous and healthy.

 

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Amy Gasbarro is Chief Operating Officer of Vālenz™, one of the nation’s leading data-driven, medical cost containment and care management organizations offering an ecosystem of expanded data and service solutions to support the self-insured industry.

Through attentive care, dedicated service and comprehensive guidance, nurse case managers make a tremendous impact on patient outcomes. As an integral part of Vālenz Care, a triple-URAC accredited solution within the complete Vālenz™ ecosystem, Valenz nurse case managers work closely with patients, providers, employers and payers to ensure the right care at the right place and time, paving a more cost-effective path to healthy outcomes.

As we recognize World Health Day on April 7 – and because 2020 has been named the International Year of the Nurse by the World Health Organization – we are celebrating the vital role nurses play in keeping the world healthy. How do nurse case managers accomplish this?

Valenz Care Management Senior Manger Sylvia Robinson, RN, COHN, says their most significant role in today’s healthcare is coordinating and managing patient care. “Care coordination is a collaborative process that involves navigating treatment with physicians, social workers, patient families and other providers, such as home health and physical therapists,” she says. “Ultimately, our goal is aimed at determining the care that plan members need and guiding them on improving health while also minimizing healthcare expenses.”

For patients, nurse case managers are the central point of contact and advocates for high-quality, lower-cost care. For self-insured employers and other professional stakeholders, they help manage health administrative costs and quality by reducing unnecessary and/or preventable emergency room visits, hospitalizations, tests and other high-dollar claim events.

“The Valenz promise is to engage early and often for smarter, better, faster healthcare, and our nurse case managers are essential to that promise,” said Amy Gasbarro, Chief Operating Officer. “Their work improves quality and outcomes while empowering our clients to move from reactive plan models to proactive population health management.”

This level of care and service results in healthier outcomes for all involved. Here are three primary ways our nurse case managers positively impact care quality and healthy outcomes:

 Patient Education and Support

By providing continuous, evidence-based guidance and education, nurse case managers fulfill a key responsibility in helping patients and families fully comprehend health conditions and treatment options, so they can stay on the path to better long-term health.

“When patients have greater awareness and understanding of the treatment plan – and when they receive support from nurse case managers – we tend to see a much better likelihood of compliance,” says Valenz Nurse Case Manager Jessica Mangum, RN, OCN, CCM.

Nurse case managers also provide guidance to patients on effectively self-managing chronic conditions, so patients can take charge of their health and be their own catalysts in making positive lifestyle changes.

“A key component of the education process is to also evaluate the patient’s understanding of that education and his or her ability to take action on it,” Robinson says. “That includes setting short-term goals that they can achieve and celebrating those successes with positive feedback.”

Avoiding Unnecessary Costs

While providing comprehensive care that is appropriate for the patient’s needs, nurse case managers strive to minimize out-of-pocket costs.

When our Nurse Utilization Managers are notified of a new diagnosis or treatment recommendation, they conduct a clinical review to determine that the criteria are met for medical necessity and ensure alignment with the most appropriate level of care, according to evidence-based guidelines for that diagnosis. This helps eliminate expenses tied to unnecessary or excessive treatments.

“When we can manage the length of stay and promote case management, we can achieve effective cost containment while providing excellent service to the members and the plan,” says Valenz Nurse Utilization Manager Staci Cunningham, LPN.

In addition, the shift in focus to proactive health management – getting regular medical care before serious illness strikes – enables nurse case managers to help reduce or eliminate the need for costly medications and physician or emergency visits. That’s a benefit for both members and payers.

Navigating the Health System

For many people, the complexities of the healthcare system can feel so overwhelming, they don’t know where to start.

“Some of the biggest challenges patients face in navigating their care is lack of understanding of the healthcare industry,” Robinson says. “The average patient does not grasp how insurance and healthcare work. They often become frustrated and give up, and then they lose trust in anyone in the healthcare field.”

That’s where a nurse case manager comes in: providing guidance and information on what is covered by a patient’s insurance, managing co-pays, controlling out-of-pocket expenses, and accessibility to care, among many other issues.

“Patients need an advocate to get them through this journey,” says Nurse Utilization Manager Nichole Barone, LPN. “We can research insurance plan documents to give patients the clarity they need; help them understand what benefits they are entitled to; determine whether they need pre-certification before treatment; and assist them in securing all those things.”

Also, people with serious diagnoses like cancer may need a wide range of procedures and tests, which can quickly become confusing for a stressed patient. “By tackling these procedures one by one, we ensure the patient gets the proper, necessary care at the correct time,” Barone says. “We support patients by guiding them through the process so they can focus on getting back to the best possible health.”

Celebrating Nurses on World Health Day

As we celebrate World Health Day in 2020, which is also the International Year of the Nurse, the recognition of our nurse case managers and the amazing work they do takes the spotlight – and it is well deserved. We are proud to acknowledge nurses’ contributions on the front lines of patient care all across the globe, and we share our deep appreciation for the critical role they play in keeping people and communities healthy everywhere.

 About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.