BlueCross CEO highlights powerful payer-patient interaction


Of all the new patterns in healthcare today, the CEO of BlueCross BlueShield of Tennessee is most surprised about how much interaction health insurers have with patients.

"We're really their guide to navigating the healthcare system," Tennessee Blues CEO Bill Gracey told The Tennesseean. Highlighting the powerful payer-patient relationship, patients sent cards and letters to BlueCross BlueShield of Tennessee, often calling out individual names out of its 5,000 employees for praise.

"You don't normally think of the payer when you think of getting healthcare. And yet, without the payer navigating them through, so many people would be lost. They get to be really good friends with their case managers who work at BlueCross," Gracey noted.

Aetna also uses case managers to offer free service and support to its patients, helping them manage their benefits, arrange care and find resources.

"Case managers are uniquely positioned to make that strong connection between helping individuals navigate [insurance choices], as well as assisting them in understanding whatever circumstance or condition brought them to need those services in the first place," Susan Kosman, Aetna's chief nursing officer, previously told FierceHealthPayer in an interview.

Through efforts including case management, Tennessee Blues employees are fostering personal relationships with patients. "They're as proud of what they do as my hospital people were proud of what they do. And they feel like they are--and they are, I've discovered--an integral part of the whole system, so that part's fun," Gracey told The Tennesseean.

Playing an integral role in improving cost and quality within the healthcare system, Health Care Service Corporation (HCSC) recently launched an intensive medical home, which employs HCSC-funded nurse care managers who offer medical and psychosocial support while coordinating and monitoring patients' progress during office visits and frequent communication, FierceHealthPayer previously reported.

Such payer-patient relationships will likely grow stronger as the industry shifts to a consumer-oriented market. UnitedHealth, for example, now uses the "very important relationship" among the consumer, the care provider and the payer to drive its overall business strategy toward greater health outcomes and affordability, Tom Paul, chief consumer officer at UnitedHealth, told FierceHealthPayer in an interview.

To learn more:
- here's the Tennessean  interview

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