Health care report: Telephone-based services boost employees’ health awareness

BY CHRISTINA OLENCHEK

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If you have health insurance, chances are good that you also have a refrigerator magnet advertising your carrier’s 24-hour nurseline. You might have even used the telephone service to figure out if a pain or illness required a trip to the emergency room or doctor’s office.

But consumers who use nurselines solely in times of crisis often are taking advantage of only a fraction of what is offered through these programs. Insurers serving Central Pennsylvania have greatly expanded their telephone-based systems in recent years to include services such as health coaching and disease management. And they’re looking for help from businesses to spread the word among their employees.

“We’re constantly looking at ways to make employees more aware,” said Dr. Robert Muscalus, medical director at Pittsburgh-based Highmark Inc., which does business as Highmark Blue Shield in this area. “I don’t think there’s ever enough awareness.”

Members who call Highmark’s Blues on Call program reach nurses who can do more than help them decide whether a medical problem requires emergency care. The nurses can serve as health coaches and work with members to help them reach wellness goals such as quitting smoking or losing weight. Members also can call the nurses to order free videotapes on topics such as cancer. The tapes help people learn more about their medical conditions and their treatment options, Muscalus said.

Dauphin County-based Capital BlueCross offers similar services through its nurse-staffed support line. Members can listen to recorded messages on a variety of health topics, including depression, menopause and breast cancer. Some members with chronic conditions use the telephone system to enter measurements such as their weight or to indicate problems such as shortness of breath. Any disturbing trends trigger alerts to nurses who will call the member’s physician. The idea is for the nurses to partner with doctors, not replace them, said

Elizabeth Barnett, Capital Blue Cross’ vice president of clinical management.

“(Members’ doctors) are in the best position to decide the appropriate intervention,” she said.

The providers who work for Cigna HealthCare’s nurseline are encouraged to look beyond members’ reported symptoms and consider what underlying issues might be causing their medical problems, said Dr. Daniel Ober, senior medical director for health advocacy and health information with the Connecticut-based insurer. For example, a nurse might inquire whether stress in a member’s life is contributing to his or her condition.

Ober believes people are often more willing to talk about their health-care concerns over the phone because that gives them a certain level of anonymity. A 24-hour nurseline also provides a convenient way to access the health-care system, Barnett said.

“We recognize that health-care decision-making doesn’t occur only from 9 to 5, Monday through Friday,” she said.

Representatives of several insurers serving the midstate said they could not provide specific data about how many people use their nurselines or how much money telephone-based programs save. Reducing the use of medical services is not necessarily the point of nurselines, Muscalus said. The goal is to help people make the most effective use of the health-care system.

“We want to be careful to see that it’s not a redirection of care,” Muscalus said. “It’s not just cost avoidance.”

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Reaching out

Even if you don’t call your insurer’s nurseline, don’t be surprised if your insurer calls you.

Representatives of several insurers serving the region reported that their companies often make calls to members who have or who are in danger of having health-related problems such as diabetes, asthma and heart disease. The insurers identify candidates for intervention using claims data, health-risk assessments and physician referrals.

The purpose of the calls is to provide information to members and to make sure they are getting the proper care, said Robert Dawson, president and chief executive officer of HealthAmerica Pennsylvania Inc. and HealthAssurance Pennsylvania Inc. The insurers have offices in Dauphin County

“The more complex the case is, the greater the need for interaction,” Dawson said. “For many people, the telephone is the best way to interact and get guidance and help.”

—Christina Olenchek