Understanding Integrated Health Care Models

Integrated health care (IHC) is a growing employee benefits strategy and an approach to health care that connects pharmacy, dental, vision and disability data to an employer’s population health platform. This includes any clinical, disease management or care management programs.

It takes health data and transforms it into real insights that give members and their health care providers a complete picture of the member’s health and help identify potential gaps in care. These insights allow for more informed care and earlier intervention for people at risk for health issues or who have chronic conditions.

Integrated Health Care Comes in Two Flavors

  • Single insurance carrier model This is a multi-way data share between benefit lines, doctors, members and care managers. This is the typical model for an employer that’s using a single insurance carrier and is much more powerful, allowing true integration across all plans offered by the insurance carrier. What does this mean in real terms? It means the carrier’s network eye doctor has the information needed to determine if a patient’s blurry vision is caused by prescription medicine. Or, the carrier’s network primary care doctor gets a care alert from the insurance carrier about a patient’s early signs of diabetes based on the results of an eye exam. Another example is the carrier’s disability claim team coordinating with their care management nurses to ensure that employees are receiving the appropriate care to get back to work quickly and safely.
  • The multiple insurance carrier model – This is a one-way data feed from the ancillary benefits lines — pharmacy, dental, vision and disability — to the employer’s population health platform. A challenge with this model is standardizing data while keeping it secure and HIPAA compliant since information is coming from different carrier sources.

The single insurance carrier model is growing in popularity, according to Anthem’s Employer Benefits Survey released in December.

Single vs Multiple Insurance Carriers

For more information on IHC, visit the American Health Insurance Plan website, which includes an article by Jeff Spahr, vice president of specialty business at Anthem, Inc.

Speak to your insurance broker to find out how you can incorporate integrated health care into your company’s benefits strategy.