This One Question Is Transforming Health Insurance

This One Question Is Transforming Health Insurance

Sponsored – When it comes to health insurance, many of us don’t think too far beyond the card in our wallet that says we’re covered.



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When people get a call from a member health advocate with their insurance company asking how they’re doing, it might come as a bit of a surprise.

“Once people realize they are on the phone with a real person from their health insurance company who cares and wants to help, they are surprised but also open,” said Lauren Clark, Member Health Advocate with Avera Health Plans.

What Is Population Health?

Involvement of member health advocates has been evolving with Avera Health Plans over the last few years. They are part of a team that also includes nurse case managers, health coaches and pharmacy experts.

This evolution is in line with the concept known as population health – in which the focus is on health and prevention rather than just treating illness or injury.

Population health as a concept is about keeping a population of people healthier, so that everyone’s costs stay lower. It’s also about helping people get the right type of care at the right time.

“We’re looking into those determinants that influence a person’s overall health,” Clark said. For insurance companies and employers, it can save on overall health care costs. For individuals, it can save out-of-pocket costs and also result in better quality of life.

“My role is getting members more engaged in their own health,” Clark said.

Her work goes beyond the traditional expectations of taking advantage of covered services like an annual wellness visit, vaccinations and recommended cancer screenings.

“Maybe the person has a transportation issue and cannot get to their regular doctor’s appointments. Maybe they need to see a specialist but live far away and don’t have the means to get there. Maybe they need help getting on board with an exercise plan or a healthier diet,” said Clark, who is trained to know what community resources exist and how to help people access those resources.

How Member Health Advocates Support You

Member health advocates at Avera Health Plans help in many ways:

  • Support members who have high medical costs. Such people may have a difficult diagnosis, like cancer. Or they may have multiple chronic conditions.
  • Consider physical/environmental factors that could be contributing to a member’s overall health.

“We had one member who had experienced numerous falls at home and kept ending up in the ER. We learned that there were a lot of rugs in the home causing that person to trip,” Clark said.

  • Explain plan deductibles, co-pays and maximum out-of-pocket amounts and what they mean for members.
  • Emphasize the importance of seeing providers that are in-network. “Going to an out-of-network provider can result in a higher out-of-pocket cost to them,” she said.

Helping people to be more engaged in their own health care and to be better advocates for their own health is an important piece of this puzzle, so Clark expects that roles like hers will become more and more commonplace in the health insurance industry.

“For us, this begins with offering our members who are at greater risk an opportunity to have a real conversation with a real person,” Clark said. “As member health advocates we believe in helping our members with their overall health care needs. We want to help coordinate services, provide education and answer questions or concerns that may help them reach their health goals.”

Learn more about these services at AveraHealthPlans.com/connect or call a member health advocate at 888-605-1331.

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