Meritain Health® - In the Booth

TCOC: Cost Avoidance and Prevention

February 22, 2021 Meritain Health Season 2 Episode 2
Meritain Health® - In the Booth
TCOC: Cost Avoidance and Prevention
Show Notes Transcript

The value that Meritain Health provides though Cost Avoidance and Prevention.

The right tools and resources let you lend the right health guidance and support to your employees and members. This includes things like:  

  • Cost and quality transparency. 
  • Employee wellness programs. 
  • Standard and specialized case management. 
  • Disease management tools. 
  • Telemedicine options. 
  • Pre-admission and post-discharge. 

Welcome. My name is Bridgette Cassety, I am pleased today to be joined by Dan Day, who is the head of middle market sales here at Meritain, and Claudia Winsett who is the head of product and operational strategy. Today we are going to be talking about the value that Meritain health provides through cost avoidance and prevention. One of our core components of total cost of care here at Meritain.  I want to welcome Dan and Claudia, and there is a lot to talk about, so I am just going to go ahead and dive in.  Dan, I thought maybe you could kick us off and just share with our listeners that when you think about cost avoidance and prevention, what does that mean to you? What do you think that should mean to our customers?

Customers are very focused on wanting to control their costs, but along with that, they want to avoid unnecessary costs. They want to build in prevention. What that means to us and to our customers is that there are really four main pillars that we focus on. We look at cost and quality and how do we evaluate that, how to measure it, how to direct members to optimize the network that we give them. We also have different ways that we manage the population health overall. Along with that, we have also tried to make sure that we have changed and led the change through the new healthcare environment that we are now experiencing. 

With that Dan, I think it would be great if we brought Claudia into that oversees our product strategy here at Meritain. Claudia, can you maybe talk a little bit about ways that Meritain helps support what Dan was just describing?

Absolutely. Bridgette. First, I will just hit on the cost. As we know, costs can really vary greatly with the same service, which means without really understanding the cost, you could end up paying a whole lot more than you really need to. I think it is equally important in understanding quality of service. As consumers we know that sometimes you get what you pay for and when it comes to your health care, you don't want to sacrifice your quality simply by paying a little less. Healthcare blue book is a tool that we use that really takes all the guess work out by providing information on both costs and quality. It's easy to use. It is easy to understand really the concept of red, yellow, and green, good, bad, and it's a way to protect our members from low quality, high cost health care.

I think that is a great point Claudia. We talk a lot about member health, we are advocates for healthier living here at Meritain. So we know it's important to both keep them healthy and to stay healthy. What are some ways that Meritain really accomplishes that beyond the healthcare blue book that you just talked about?

Well, we have lots of ways of doing that. One way I'll talk about is through our healthy merits wellness program. We have products that meet member needs wherever they are in the health journey. So sometimes it's about getting better. So maybe you have a disease, or you have a particular issue that you're having with your health and really it's, how do we get you better? For some folks it is really do we sustain the health that we have already achieved. So what we do is we implement solutions that address really the biggest cost drivers, things like diabetes, and we can design solutions that are very specific to a client's unique population. We understand no two populations are equal. They're not the same. They certainly don't come in a box, so we can definitely create specific solutions. We create connection points, which I think is so important when you think about a health journey and we address the whole health in a very holistic way. We address multiple needs across the spectrum of wellbeing. We understand that you can't just address a specific need. You have to understand all the ancillary needs so you can more effectively support the journey. I will give you an example, someone who is working on nicotine cessation may also benefit from stress and weight management coaching. Somebody who is working really hard to control their diabetes may also benefit from striving their purpose personal health and wellness challenges. Creating social connections to keep them engaged and motivated, staying active, to support their overall wellbeing. Lastly, we know is so important, it is really the emotional wellbeing.  We are so fortunate to have access to Aetna resources for living. Aetna Resources for living really addresses the broad spectrum of emotional health. It is really all the things that contribute to it. It is the financial pieces, it is the physical pieces, it is the emotional pieces and really an incredible way sort of broadly with a lot of different resources, addressing that spectrum of needs.  

I like what you're talking about, because what you really are bringing into focus for us is that holistic approach, the customization approach that brings in all the factors, which is really so much of what drives total cost of care.  I just have one last question I wanted to go back to you on, and that is, how do we make that easy for members when we talk about access and what innovative solutions are we bringing to the table to really support that journey and meeting members where they're at?

Understanding the growing importance of care delivery. As you mentioned in a really rapidly evolving virtual world. We're looking at solutions that provide the same kind of high quality care that our members have become accustomed to. Just a little slightly different way while we'll continue to look at ways to expand traditional uses of telemedicine. Like we have seen, particularly in the last several months in settings like clinics. We are also looking at things like virtual second opinions and expanding different channels and ways of connecting. Things like texting capabilities, many of our solutions today offer the ability to deliver comprehensive services digitally like Lavango and healthy merits our wellness program. We can offer some really great services. We can do those virtually digitally, but we are always looking at what's next. How we can continue to simplify services that drive prevention and cost avoidance, like Dan mentioned.

That is perfect Claudia. Dan, I am going to turn back to you as we sort of wrap up our time together today. Claudia certainly covered a plethora of options that we have available here at Meritain, but I was just curious if you wanted to share with our listeners, what you see as Meritain’s number one, advantage that when we talk about cost avoidance and prevention, that they should really take it, some of the key, the key take away from our conversation today, what would you focus on?
Bridgette I would focus on the fact that we listened very intently to both our customers and the consulting brokerage partners that we work with. Along with that, we also look very far ahead into the future to see what really could benefit our overall membership. With that, we have a group of people that we formed a health innovation and transformation unit that basically looks at different solutions that could provide our customers and members an advantage in being a tenant to cost avoidance and prevention. We look ahead. I think the fact that we are leading the market in this change is really what gives us the number one advantage. 

 Dan, I think you are spot on with that. When I think about what we are speaking of today in cost avoidance and prevention, that really what we are focused on is what's next, right? Leading the charge and what's next and bringing that innovation to our brokers, and to our plan sponsors, and to our members. So I want to thank both you Dan and Claudia for joining me today. I want to thank our listeners for tuning in and for joining us for more sessions to learn more about Meritain total cost of care.