Providing personal touch’ increases satisfaction
Plan’s CMs provide outreach in a variety of ways
The personal touch pays off for a health plan, Terri Cox Glassen, RN, MN, asserts.
As assistant vice president for consumer satisfaction at CIGNA HealthCare, Cox Glassen is in a position to know.
CIGNA HealthCare, with headquarters in Bloomfield, CT, employs about 3,000 nurses in a variety of roles, many of them in programs that provide outreach to the members.
"Nurses are advocates by nature, and in managed care there is a lot of opportunity for nurses to play the advocacy role by helping members navigate the health care system," Cox Glassen says.
The nurses do everything from patient education to working with members in disease management programs to helping facilitate care through the continuum.
"People love it when nurses call them. In addition to improving member satisfaction, we find that the personal touch does help with health outcomes. For instance, we have a high rate of success in our disease management program, along with a high member satisfaction rating," Cox Glassen says.
Personalized support
The personal touch pays off in other ways for the health plan, she adds.
For instance, one member received a call while considering an open enrollment option. She was so impressed by the personal call, she decided to stick with CIGNA and told the case manager she was recommending the plan to her friends.
"This is another example of how the personal touch has made a difference," Cox Glassen says.
Among the health plan’s outreach services are a 24-hour help line, staffed by nurses, disease management services, and on-site case management in some hospitals.
CIGNA HealthCare’s disease management programs were initiated in 1998. Other nurse programs, such as the 24-hour help line, have been in existence for about five years. The company has had case managers for eight years.
"People don’t have to be in the hospital or faced with a chronic decision to receive personalized support. Our member support is based on individual situations," Cox Glassen says.
The health plan’s disease management programs are geared to patients with asthma, diabetes, low back pain, and cardiac disease.
"We focus on helping the healthy stay healthy and helping those with chronic illnesses have good quality of life," she says.
The disease management nurses contact the patients by telephone at intervals based on severity. It may be weekly for more severe patients or quarterly for patients who are doing well.
Each year, CIGNA looks at a variety of data including profiles of members, such as age ranges and specific clinical characteristics, drugs prescribed and filled, hospital admission rates, and tests ordered and conducted and their frequency.
The statistics help the insurer decide on the most appropriate disease management program.
The disease management programs have been highly successful for the plan, Cox Glassen adds. For example, the Well Aware diabetes management program showed a 26.6% improvement in nephropathy screening for potential kidney complications and an 11.2% improvement in eye examinations.
Among members who participated in the Well Aware diabetes program, hospital admission rates per 1,000 members dropped 20.8%, and inpatient day rate per 1,000 members declined 22.7%.
In a member satisfaction survey conducted by an outside firm, Well Aware participants gave a rating of 7.2 on a 10-point scale for having more control over their health than before they started the program. Those surveyed gave an overall satisfaction rating of 3.9 on a scale of one to five.
Cox Glassen has found that members are more likely to participate in disease management and other programs if they are proactively enrolled and given the opportunity to opt out rather than just offering the service as an option.
"People are busy and get bombarded by multiple services. It’s better to reach out to members rather than waiting for them to come to you. The key to success in getting people involved in their own health is the personal touch," she says.
Nurse case managers from CIGNA HealthCare work on site in some hospitals, visiting the patients and making sure they have the appropriate education to go home safely, helping with discharge planning, answering financial questions, and giving support to members and their families.
"The nurses are assigned to hospitals based on geographical location and different situations with the hospitals. Their job is focused on helping patients in the hospital with whatever they need," Cox Glassen says.
A 24-hour telephone service, which is staffed by nurses with a clinical background, provides feedback to members with health care questions. In addition to answering general health and wellness questions the nurses help people who are having symptoms of diseases choose the most appropriate level of care. For instance, they help people with chest pain decide whether it is indigestion or could be something more serious. If a parent calls in the middle of the night with a sick child, the nurses help them decide if they should take the child to an urgent care center or wait until morning to see the pediatrician.
"They are here to give the members peace of mind," Cox Glassen says.
The personal touch pays off for a health plan, Terri Cox Glassen, RN, MN, asserts.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content