Aug. 12, 2019

This paid piece is sponsored by Avera.

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.

So when health insurance plan members get a call from a member health advocate asking, “how are you doing… is there anything I can help with,” 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, a member health advocate with Avera Health Plans who also has a master’s degree in social work.

Involvement of member health advocates has been evolving with Avera Health Plans over the past 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.

“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.

She encourages members to take full advantage of covered services such as an annual wellness visit, vaccinations and recommended cancer screenings, but it goes beyond those traditional expectations.

“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.

Currently at Avera Health Plans, member health advocates provide support to members who have experienced high medical costs. Such people may have a difficult diagnosis like cancer. Or they may have multiple chronic conditions.

Clark helps them understand what their plan’s deductible, co-pay and maximum out-of-pocket amounts mean for them.

It’s also important for people to understand 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.

While she was earning her master’s degree, Clark worked in home and automobile insurance. That background is helpful in her role today because it’s made her realize that many people don’t understand all the ins and outs of their insurance policy. “I might seem like just a piece of paper.”

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.

To learn more, visit AveraHealthPlans.com.