Just as many other industries have gone through the transformation from small, locally owned businesses to large national corporations, healthcare is moving in a similar direction. These changes bring many benefits, including capital investments, infrastructure, and knowledge. Despite these changes, though, healthcare is still local, and its businesses must respond to the unique needs of the communities they serve.
While Connecticut is considered a very wealthy state, with an average population of healthy, financially well-off residents, averages can be deceiving. The state’s largest cities are among the poorest in the country, and many of them make up ConnectiCare’s core membership. This fact is not lost on Robert Kosior, senior vice president and chief risk officer for the company, or on most of its employees. While many health insurers across the country have walked away from the individual health exchanges created by the ACA, ConnectiCare is one of only two insurers offering coverage to individuals through Access Health CT, Connecticut’s health insurance exchange.
In addition to the individual market, ConnectiCare’s business primarily includes small businesses, cities, towns, local municipalities, and retirees enrolled in Medicare Advantage. “Our members are among those that carry the highest burden due to rising healthcare costs and take on the overwhelming task of navigating through an increasingly complex system while tackling health literacy,” Kosior says. “Our mission is to create healthier futures for our customers and communities. In order to do this, we must continue to work toward making healthcare more affordable and ensuring that our members can easily get the care they need.”
Here’s a look at how the company succeeds.
Keeping it Local
ConnectiCare’s local presence is a key advantage. Its employees are part of the communities it serves. “I’m a lifelong Connecticut resident,” Kosior says. “I spent fifteen years of my career commuting over the border to Massachusetts, and I am grateful for the opportunity to positively impact healthcare in my own community. We know our providers, understand the individual needs of our members, and can connect them to local resources. That said, we keep the local market top of mind when identifying and executing our products, processes, and strategies.”
ConnectiCare’s member call center is located at its company headquarters in Farmington, Connecticut. The company has also opened a number of retail locations across the state to further engage with its members. “Our retail centers provide a unique face-to-face experience,” Kosior says. “Members come in to get answers to benefit questions, find the right provider, understand and pay bills, and attend educational programs and health and wellness classes.”
In addition, ConnectiCare recently invested in community resource coordinators, who help members access additional resources within their community to help with their broader needs. “As an industry, we have just started to acknowledge the impact that socioeconomic issues have on people’s health,” Kosior says. “How can we expect someone with diabetes to control their blood sugar when they are worried about putting food on the table, a place to sleep, or a safe environment?”
ConnectiCare’s local focus also influences its relationships with hospitals, physicians, and other healthcare providers. “Our goal is to be more engaged, responsive, and accessible with our provider network.”
Kosior acknowledges that this is becoming more difficult, given the continued consolidation of healthcare, which means that decisions that were once made locally are increasingly being made out of state. “The sphere of influence has now expanded beyond our state borders, which we have adjusted to, but the delivery of care is still local, and these relationships are more important than ever,” Kosior says.
This is because improving cost and quality requires a higher level of engagement with the provider network. ConnectiCare has a dozen provider collaborations across the state, where it partners with primary care and multispecialty groups, integrated delivery systems, and other organized provider groups to manage the healthcare needs of its members. “We aim to use these partnerships to drive improvements in cost and quality,” Kosior says. “Our role is to support our provider network in the efficient delivery of healthcare services through data-driven insights on our members.”
A Data-driven Response
Healthcare data analytics is an area that has received tremendous attention and is key to making progress when it comes to cost and quality. The space is changing rapidly, and the risk is that smaller health plans can be left behind. So far, that has not been the case for ConnectiCare.
“We have made significant investments in this area and are fortunate to have a staff of highly skilled and dedicated individuals with expertise in programming, data analysis, actuarial, statistics, and healthcare management,” Kosior says. “Information is key. We are a data-driven organization; we use this for informed decision-making and to help our providers understand their patients’ needs, drive better outcomes, and improve quality—while at the same time managing costs.”
Kosior notes that Care Management Solutions Inc., an affiliate of ConnectiCare, helps do just that. “Data-based programs, like the offerings through Care Management Solutions, are based on clinical evidence, claims data, and behaviors of each individual to help activate members to engage in preventive measures and chronic disease management,” Kosior says. “It’s proven effective. Using data to help employers keep their workforce healthy and productive is crucial to running successful businesses. “
A Look Ahead
Through its provider collaborations, ConnectiCare has seen emergency room visits and acute bed stays drop by 9 percent and 16 percent, respectively. Additionally, primary care visits have increased by 30 percent.
Though results have been positive, Kosior acknowledges that much more needs to be done. “I’ve yet to hear that enough has been done to improve healthcare,” he says. “Until then, we will continue to make changes. The path we have chosen is to work with our providers and not in conflict with them. This approach is far more effective, rewarding, and keeps the member or patient at the center of the conversation.”