What’s a Medical Manager?

In theory, your health insurance plan is supposed to keep costs down, in part by helping guide your employees to lower-priced, higher-quality care. The people who do this work are called Medical Managers. They work for your health insurance company, and interface directly with your employees and their doctors to guide care. Never heard of them? Well then, you have to wonder stringently the insurance company is trying to manage your costs.

Most employers are unaware that Medical Management already exists on their health insurance plan. And it’s affecting costs in surprising ways.

Medical Management falls into two broad categories: Disease Management and Case Management.

Disease Management attempts to help employees manage chronic conditions over the course of a lifetime. As an example, employees with Type I Diabetes can benefit from strong Medical Management. By giving your employee the tools to ensure medication compliance and help with healthy lifestyle choices, they may help that employee feel better and avoid expensive hospitalizations. When done right, the health insurer will both help them improve quality-of-life and keep your costs down.

Care Management addresses more acute situations: mapping out a treatment plan following a cancer diagnosis, or helping an employee choose where to have an orthopedic surgery. When facing a stressful medical situation, we should not expect employees to navigate the healthcare system on their own. Good Medical Management will balance the need for your employee to feel they are cared for, with the need to prioritize doctors and hospitals that make financial sense.

The rubber hits the road on Medical Management when it comes to the concept of steerage. The creativity and flexibility available to you under a self-funded plan allows you to steer employees towards care that is both excellent and of value. You have the flexibility to select Medical Managers for your self-funded plan that will help your employees select care centers that represent the best value. And you can incentivize an employee to follow their treatment plan through copay or deductible relief.