Proactive screening, treatment key to True Health’s goals
For True Health New Mexico, supporting the wellness of its members is a priority. “A traditional health plan pays a claim and only interacts with you when you’re sick,” said Dr. F. Kiko Torres, True Health chief medical officer. “We take care of members who are ill, but our goal is to do more than that. Our motto is to be not just a health plan, but also a plan for health.” THNM, which was launched on January 1, 2018 as a commercial health plan, manages the health care coverage for more than 40,000 lives. In addition to providing services for its employer group business, THNM also provides medical management and operational support for New Mexico Health Connections, which provides insurance for individuals. “From our inception we’ve been a plan that promotes wellness both for our members and our employees. Our philosophy is based on helping people achieve their personal best health status. Encouraging and promoting wellness is fundamental to reaching that goal,” Torres said. To ensure members and employees strive for wellness, THNM looks into three components — physical, emotional and social health. Torres said that THNM understands that mental health and physical health are vital component to maintaining wellness. One of the first steps is to break down the barriers that may inhibit THNM members from getting the most appropriate care. “Our benefits are structured to eliminate barriers to care. We have zero-dollar co-pays to ensure members with chronic conditions are able to access the generic medications they need,” Torres said. “We also have zero-dollar co-pays for outpatient behavioral health visits and for many generic versions of behavioral health medications. We understand that there can still be a sense of stigma for people seeking behavioral health services; we focus on normalizing mental and emotional health needs.” Staving off illness and disease with a proactive approach to member care is a key strategy for True Health. “We’ve invested in building a robust medical management team,” Torres said. “Our medical directors, nurses and case managers focus on proactively engaging our members — even before they get sick. We have a program designed to ensure our members have a primary care physician. Members are connected to a PCP because having a primary care doctor is a starting point for improving health outcomes.” Early engagement is so important that True Health commits significant resources to the issue. “Having a higher percentage of medical management staff than a typical health plan our size is part of our strategy of real engagement,” said Lydia T. Ashanin, senior director of marketing and communications. “We’re able to leverage data to help us understand who might be showing early signs of diabetes or COPD or asthma. We can intervene before chronic conditions become serious or life-threatening. We talk to members early in the process to help them stay as healthy as possible.” THNM cares about their members and reaches out to them to offer a helping hand especially at critical times. “When a member is discharged after a hospital stay, we reach out to them to ensure they have all their medications and that they understand how to use them.” Torres said. “Not everyone has all the resources they may need at home — our goal is to make sure they have information and support appropriate to their situation.” True Health uses several strategies inhouse and with members to try increase engagement and keep it fun. For instance, members older than 18 are offered a credit for a free or reduced-price Fitbit, said Leia Phelps, True Health director of operations.
“Not everyone can make it to a gym, but everyone can increase their activity level. Increased activity level helps promote better health,” Phelps said. THNM offers a Fitbit community to encourage everyone including the general public, members and employees to get their exercise in. “The community is open to anybody. You don’t have to be a True Health member or have one of our Fitbits,” Phelps said. “We engage with the community and our members to promote participation in challenges.” Some challenges in the Fitbit community include steps and for activity minutes. “We have teams established so that participants can either challenge themselves, or have a friendly competition with others,” Phelps said. “We recently did a ‘Beat Your Boss’ challenge and Kiko was our star — everybody in our community tried to beat his number of steps.” The program appeals to many different types of employees, even those who don’t want to be competitive, said Rory Cobb, True Health channel manager. “We found that actually wearing the Fitbit mentally encourages people to do more activity,” he said. “It’s not a carrot or a stick. It’s a tool that somebody can use regardless of where they are in their overall health.” Data seems to validate that the True Health New Mexico models of care management and wellness promotion are working. “We now have enough of a track record to show that we’re doing something right for our members,” Ashanin said. “Our hospitalization rate is lower than our competitors and the national average. Our emergency room visits were also lower. These outcomes show our model of proactive engagement is doing what it should be doing.”