Monday, June 27, 2011

What to Expect When a Nurse Calls and Why You Should Take the Call

Most of us are suspicious when we get a phone call from our insurance company. Our first thoughts are often that they're going to try to get out of paying for care that we need. And, some of us are reluctant to share our personal health information with our insurance company. UHC has a program called e-sync that I saw a demonstration of last week at the UHC Customer Forum. E-sync is a platform that UHC developed using hundreds of algorithms to identify opportunities for members to improve their health. 

In the demonstration, the nurse reached out to a member because she had not filled a prescription recently for medication to control her blood pressure. When the nurse talked with the member, she learned that the members' doctor had retired, so she found a preferred provider for her and made her an appointment. The nurse also asked if the woman was monitoring her blood pressure at home and when the woman indicated that she did not have a blood pressure monitor, the nurse ordered one to be sent to her free of charge. She also sent her a log so that she could record her blood pressure and take it to her doctor appointment. Then, she arranged to follow-up with the member after she saw the new doctor to find out how her appointment went. UHC's focus is on personally appropriate interactions. In other words, they'll help you take the steps you wish to take. 

If you get a phone call from a nurse at UHC, there was something in your record that caused you to be flagged by one of the algorithms. These generally fall into one of the following eight categories:
  1. Disease-Drug Interactions: Member filled prescription that is not recommended for their condition. For example, NSAIDs are contraindicated for individuals with chronic renal failure.
  2. Disease Monitoring Gaps: Member has a condition or is on a medication which requires follow-up care. For example, Member is taking digoxin and national standards call for testing their kidneys and blood potassium.
  3. Therapy Duplications: Member has filled two or more prescriptions for the same class of drug. For example, Member is filling prescriptions for two or more statin-containing medications.
  4. Missed Therapy Intervention: Member does not have a needed medication for the treatment of their condition. For example, Antiplatelet therapy compliance for a member who has received a stent. 
  5. Potential Medication Adherence Issue: Member not taking recommended dosage of prescribed medication. For example, Member with rheumatoid arthritis is not compliant with their medications.
  6. Medical Management Consideration: Member whose specific condition requires follow-up care or testing. For example, woman with a history of breast cancer should be receiving yearly mammograms. 
  7. Drug-Drug Interactions: Member who is concurrently taking two contraindicated medications. For example, Nitrates and Phosphodiesterase. 
  8. Money Savings Tips: Opportunities for over-the-counter drugs, lower-tier switching and half-tablet alternatives. For example, Member taking Crestor may save money by participating in the half-tablet program.  
These calls from a nurse can be informative and helpful. You won't be bound to act on the information the nurse provides and the nurse is not in a position to dictate what care you receive or limit your access to care or medications. If you're hesitant to talk to the nurse because you don't want to share your personal health information, well -- that train has already left the station. UHC knows what medications you take, the results of your last lab tests, the doctors that you see etc... E-sync integrates all that data so that they can assist you in a holistic way. So, why not take the call? You might learn something that helps you improve your health. 

The attached flier describes the Nurseline service. You can also reach out to a nurse by calling the Care 24 number on the back of your insurance card (888-887-4114) or clicking on the Live Nurse Chat button in the bottom right hand corner of 

Note: UHC shared that they are able to close a gap in care 95-96% of the time once they get the member on the phone. Their ability to get the member on the phone varies from 2-60% and is largely dependent on how much the employer has done to educate people about the program. 

UHC's NurseLine

1 comment:

fayetteville nc dentist said...

At least they're able to provide appropriate health care assistance. You can opt for other service as well.