How to steer your members to high-quality, cost-efficient providers

As part of an Arkansas Blue Cross and Blue Shield health plan, your workforce and their families have reliable access to care. Our network extends nationwide and covers 1 in 3 Americans on a Blue plan. We also have an expansive network with more than 2 million unique providers. Within Arkansas, 98% of providers participate in our network, as do 100% of Arkansas health systems (only two standalone ERs are not in our network). Many of our fully insured and self-funded health plans also supplement in-person provider visits with telehealth options to increase access to care and convenience for your members.

This means that not only do your members likely have providers accessible to them, but they also often have their choice of providers and facilities.

Navigating choices

But not all providers and facilities offer the same quality of care or charge the same amounts. Without informed guidance, members may pick a provider without having a sense of their reputation or whether they are competitively priced.

That’s why Arkansas Blue Cross has built-in tools and guidance to help your employees and their covered family members understand where they can find the most affordable, clinically appropriate care.

Tools, tips and flyers to share with your workforce

Healthcare and health insurance systems can be overwhelming, so people often appreciate some help navigating to the highest quality healthcare their plan covers at the best cost. As a group administrator, you can share these resources with your workforce. We encourage you to explore and share our Getting Started materials in our downloadable employer toolkits.

We also have easy-to-share information here on health programs that may be part of your plan; case management, prevention and behavioral health resources; and a valuable guide to health insurance basics.  Cost-efficient care that improves members’ health saves your plan money, but it can also help out their family budgets.

Here are some suggestions you can share with your employees to find providers proven to deliver strong results:

1. Call our customer service using the number on the back of the member’s ID card. Our experienced customer service representatives are ready to help your employees understand their plan, their financial outlay and coverage. They also can help locate in-network providers who are known to provide excellent care at the best value. Members can call the customer service number or securely message their questions through Blueprint Portal.
   
   
2. Use our Find Care & Costs self-service tool on the Blueprint Portal website and mobile app. Our free, downloadable digital toolkits for employers have printable or shareable PDFs of communications in English and Spanish to help explain how to sign up for Blueprint Portal and Use the Find Care & Costs tool.
   
   Members can search for providers by name or specialty and can refine their search with more than a dozen filters including things like gender, accepting new patients, languages spoken by staff, board certification and other factors. Users can also search for in-network facilities and practices, either by name or type.
   
   Looking a little deeper, your employees can explore providers’ quality ratings and member feedback using this tool. Some provider and facility listings include industry quality information and ratings from other members.
   
   Another way Blueprint Portal (and our call center representatives) help steer members to high-quality, high-value care is by prioritizing the facilities with proven track records. For instance, certain facilities in the Blue system are marked as Blue Distinction Centers (known for above-average outcomes) or Blue Distinction Centers+ (known for above-average outcomes plus cost-efficient care). To help encourage your members to consider these top facilities, we automatically sort facilities with these and other industry quality designations toward the top of the search, unless the member chooses to sort by another method, such as distance or alphabetical name.
   
   Using Find Costs, members can research average costs for procedures they may be considering or that their providers have recommended. These cost estimates come from the historical claims of the millions of members across the nation and the locally negotiated rates from providers and facilities. Blueprint Portal gives each member an estimate of what they can expect to pay based on their specific coverage policy, claims, deductible amounts and out-of-pocket expenses to date.
   
3. Members of groups that have Celeste with Accolade can access Celeste’s enhanced Find Care search. Using the Accolade app or phone number, members can use their Celeste benefits to locate even more personalized advocacy and navigation services. Celeste employs dedicated Find Care specialists to help match members with the best provider for their needs. The Find Care specialists have deep information about providers and the members’ care. They work with members one-on-one to connect them to the most clinically appropriate, timely, convenient and cost-efficient care from in-network providers and facilities and inform them of their options.
   
4. Explore your plan’s telehealth benefits. Most plans offer some level of telehealth care. Whether via telehealth visits with brick-and-mortar providers or virtual specialists and providers from telehealth point solutions, accessing virtual health can help increase your members’ access to care and can help lower costs. Fully insured Arkansas Blue Cross and Blue Shield plans and some self-insured plans offer an array of point solutions that can provide high-quality, cost-effective care to members.
   
   For instance, Celeste’s offerings include our Expert Medical Opinion service that can be especially helpful in situations where members are facing a serious diagnosis or costly procedure. After sharing their medical records, they connect for a telehealth appointment with one of the top specialists in the nation for their condition. The provider visits with them and does a full review of their records before providing them with an expert second opinion. The advantage of this service is that instead of waiting weeks for an in-person appointment that might require expensive travel, they can receive a second opinion within days from a highly qualified physician who has fully examined their case. This expedites care and, in some cases, may lead to a different, less costly or invasive plan of care.

Your workforce and their covered dependents get the most value from your health plan when they understand how to use it, whom to call and how to find the information to make smart health and financial decisions. As an employer, you can build appreciation for your benefits by helping them feel confident navigating to find the help they need, when they need it.