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Wellmark programs reach out for preventive care


Wellmark Blue Cross and Blue Shield of Iowa wants you to be healthy. So don’t be surprised if they send you some tips for staying healthy, tailored to your personal medical information.

Just had a baby? Wellmark will send you a postcard with information about immunizations. A woman over 40? You’ll get information on mammograms. Have diabetes? You’ll see a reminder to get an annual retinal exam.

The insurer also reaches out to policyholders with more serious health conditions, such as cardiovascular disease, asthma and diabetes, through its disease management and case management programs.

Given rising health-care costs, “I think that our employer groups are increasingly demanding these services from their insurer,” said Judy Stark, vice president and director of health management operations for Wellmark. “In the past 18 months, there’s been a huge increase (in requests) from employers to equip them with tools so their employees can make better decisions about health care.”

Wellmark nurses keep in contact with the its most seriously ill policyholders by telephone through the case management program, and provide more general information in the mail through the disease management program.

The insurance company offers the three programs to its employer groups in Iowa. Participation is voluntary, and among those targeted for the case management and disease management prorams, only 2 to 3 percent opt out, say Wellmark officials.  

About 1 percent of Wellmark’s membership accounts for about 30 percent of the dollars paid out for health claims, so focusing on the those high-dollar cases through case management makes good business sense. Additionally, the disease management program seeks to keep people out of that high-cost category.  

Cost, however, is not the overriding issue, Stark said.

“Our goal is not for members to get cheap care; it’s to get quality care,” she said. “For the most part, these programs are encouraging patients to access care properly and to be given care according to national standards of care.”

The programs have generally been received positively by physicians, said Carlin Moser, group leader of the Wellmark’s care coordination unit.     “We in case management are able to put all the pieces together,” she said. “So they see us an advocate and the response is favorable.”

Wellmark also measures the satisfaction of members who have been contacted through the programs, “and that satisfaction is fantastic,” Moser said.

To administer the case management and disease management programs, Wellmark employs a team of about 45 nurses, along with a support staff of about 10 people. Nurses must have at least five years of experience to qualify to work in the programs.   

Wellmark’s case management program has been around since the advent of managed care in the early 1980s.   

The insurer began its postcard reminder program, known as BluePrints for Health, in 1997 for individuals covered under its HMO plan, and extended it to its PPO-covered policyholders in 2001.

Since that time, immunization rates among children in the covered groups have measurably increased, as well as the number of people seeking preventive health screenings, Stark said.   

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