2023 Pinnacle Awards Go to Elevance Health/Anthem Blue Cross Blue Shield and Molina Healthcare of Ohio
2023 Pinnacle Awards Go to Elevance Health/Anthem Blue Cross Blue Shield and Molina Healthcare of Ohio
Ohio Association of Health Plans (OAHP) honors advances in personal digital care management, behavioral health treatment
Columbus, Ohio — This year’s Pinnacle Awards from the Ohio Association of Health Plans recognize Elevance Health/Anthem Blue Cross Blue Shield and Molina Healthcare of Ohio, for an app that provides personalized digital case and disease management and a care model focused on providing hope for children with severe emotional disorders and adults with serious mental illness.
OAHP presented the awards on Sept. 26 at its Annual Convention & Trade Show in Columbus. They are given each year to two OAHP member health plans that have developed innovative approaches to health care’s most difficult challenges.
“Being able to showcase our members’ best work through the Pinnacle Awards is a highlight of every year for our organization,” said Kelly O’Reilly, OAHP president and chief executive officer. “We always hope that these examples will inspire even more passion for innovation.”
Elevance Health/Anthem Blue Cross Blue Shield: Concierge Care
The Concierge Care program, delivered via an intuitive, personalized member-facing app, is all about overcoming the barriers members face to maintaining optimal health — lack of transportation, inflexible schedules, low information, poor access to information resources and more.
Those barriers make it difficult to attend in-person appointments, keep track of medications, ensure proper nutrition — all of the behaviors that can make the difference between good and bad health outcomes.
Elevance Health members use the app to track health data and symptoms, link to data from personal health devices, set personal goals with customized care plans, set medication reminders, research conditions via a library of curated videos and articles and get instruction on self-directed health exercises such as breathing and mindfulness. Among the most popular features is the availability of real-time, on-demand consultation with care managers, who can answer questions and participate in chats.
Care managers work with members to build personalized care plans to help them achieve and sustain their health goals. For needs that can’t be served online, they connect members with providers, nutritionists, labs and behavioral health specialists.
Members who have used the app say it works because it is convenient to their lifestyles and schedules. The personal care managers motivate and guide them and hold them accountable.
“We know that virtual engagement with technologies like Care Concierge can help people manage chronic conditions, and that’s good for members and their employers alike,” said Jane Peterson, president of Anthem Blue Cross Blue Shield of Ohio. “We’re grateful that this award will increase awareness of what it can do.”
Participants in a trial program made high use of Care Concierge, with 77% using the app to track health data and symptoms and 57% initiating chats with the Elevance Health/Anthem Blue Cross Blue Shield care team. A preliminary analysis of claims shows an impressive difference:
- 39% drop in outpatient ER use.
- 60% reduction in admissions for chemotherapy-related side effects.
- 25% improvement in Crohn’s Disease symptoms and flares.
- Lower A1c scores for members with Type 2 diabetes.
- Lower anxiety and depression levels for those in the behavioral health program.
Molina Healthcare of Ohio: Serious Mental Illness & Severe Emotional Disturbance (SMI/SED) Care Model and Helping Other People through Empowerment (HOPE) Program
Recognizing that members with SMI/SED diagnoses are more difficult to engage in treatment because of their cognitive symptoms, Molina designed a care model and a specialty team to combine a wide variety of expertise and specialized tools to address the challenges.
The model supports adults with SMI and children up to age 17 with SED.
A new team created to work with members who struggle with severe and persistent mental illness (SPMI) brings experience from different clinical backgrounds including community mental health centers, hospitals and forensic settings. Team members strive to empower patients and inspire hope — a critical asset often lost to people with SMI or SED.
“Meeting the needs of members with severe mental illness is among the greatest challenges a health plan faces and Molina is proud to leverage its experience to create an innovative solution,” said Ami Cole, plan president of Molina Healthcare of Ohio. “We’re passionate about the difference our model and the HOPE team can make for our members.”
A key concept in the model is the importance of building alliances with patients — using trauma-informed care and motivational interviewing, clinicians guide patients toward needed changes with acceptance, compassion and partnership, rather than directing them.
The program has three fundamental goals:
- To provide support and assistance that improve health outcomes.
- To address social determinants of health.
- To lessen functional impairments and improve overall well-being.
Molina assesses success by monitoring members’ use of crisis services, emergency rooms and inpatient stays. The program also monitors member self-management via education, coaching and treatment adherence. It assesses the member’s ability to use a personal safety plan in case of crisis and looks for regular outreach to treatment, providers and other supports.
Over 12 months of the program, Molina saw a reduction in unnecessary use of services by SMI members in the two highest-risk categories, yielding an 8% savings.
Overall, per-member, per-month spending was 30.5% lower for those enrolled from the program’s implementation.