By Thomas Vincz, Public Relations Manager

For someone with a chronic condition like diabetes or Crohn’s disease, the number of worries – physical, emotional and simply logistical – can be mind-numbing. Finding the right doctors, coordinating care, scheduling appointments, navigating lab tests and filling prescriptions – the list goes on.

Now for employees with these conditions, imagine that they’re also concerned about getting the most from their health plan. One more thing: they need the support to change behaviors that contribute to their condition so they can be the healthiest they can be. All while remaining a productive part of your workforce and managing life at home.

If this seems like a lot to ask employees to handle by themselves, you’re not alone in thinking that. According to a recent HealthMine survey of consumers with employer-provided health insurance, sixty-one percent of respondents view their health plan as “cookie-cutter” and designed for the masses, rather than personalized or customized to their needs. Seventy-three percent say their plan does not reflect their current health needs very well.

To address that, and drive improvements that can lower costs and reduce employees’ time away from the job, many employers in New Jersey are choosing to give their workforce much needed extra help and support. Horizon Blue Cross Blue Shield of New Jersey’s (BCBSNJ) Primary Nurse Program (PNP) achieves those goals.

Now in its fourth year, Horizon BCBSNJ’s PNP provides employers with dedicated registered nurses who can help their employees feel more engaged with their own health care. These nurses are able to coordinate care among providers, provide educational and emotional support to patients and their families, and help Horizon BCBSNJ members get the most out of their benefits.

About 20 employers currently use the PNP, covering about 450,000 Horizon BCBSNJ members. In 2018, 8,968 members were engaged through a company’s PNP – up 37 percent from a year earlier.

“This value-added program has proven to be successful at both improving employees’ engagement in their health and in delivering greater employee satisfaction,” said Timothy Harbison, Director of Sales and Account Management for the Large Group Market at Horizon BCBSNJ.

What companies like most about the program, said Harbison, is that they can customize it to their needs. They can select the number of nurses – some companies have one while others have as many as six – as well as their expertise. For example, employers with a significant number of employees being treated for cancer can choose PNP nurses who have a deeper background in oncology and who know how to help manage and care for the unique and specific needs of those patients.

Employers also like the high-touch level of service, says Katharine Osborn, director of HR and benefits for a New Jersey-based insurance company that uses PNP. The nurse dedicated to working with her company has been “the face of Horizon,” Osborn said.

This nurse, who helps employees navigate care and find treatment alternatives, provides “the kind of personal service that people crave,” said Osborn. “Employees don’t want another app or an email. The best way to change behavior and get someone to start leading a healthier lifestyle is by talking with them and creating a personal connection.”

Reaching out early to make the biggest impact

Unlike traditional case management programs, the PNP doesn’t wait until a patient has been overwhelmed by the health care system, piling up claims. The Horizon PNP – through partnerships with physicians, pharmacies and imaging providers – can intervene right at the beginning of a patient’s care.

“We can know from the first x-ray, long before we get the first claim, when a member begins a course of treatment for a serious condition,” explained Harbison. Hospital admissions, certain diagnoses, or referrals from an HR department or case manager, can also trigger a PNP nurse to reach out.

This early intervention is critical to put members on a path toward their best health. “Early on is the best time to engage members,” Harbison said. “If they’re too far down the road, it’s hard to steer them in the right direction.”

Once members are in treatment, Harbison compares the primary nurse to a “quarterback," connecting patients to the right clinical resources and helping them leverage their benefits to the greatest degree possible. In fact, PNP nurses, who work for only one employer group at a time and understand the customer’s complete benefits program, can help members tap into benefits beyond health insurance, like employee assistance programs.

Colleen Kenkelen, RN, certainly embraces the role of quarterback. A nurse care manager with the PNP at Horizon BCBSNJ for the past three years, Kenkelen has a clear idea of what makes her job so fulfilling.

“I get to help patients achieve their goals and embrace a healthy lifestyle,” Kenkelen said.

This might range from helping a patient who had a traumatic brain injury transition to at-home care to the time when she supported a Horizon BCBSNJ member who had a goal of taking a once in a lifetime vacation.

That member had gastric bypass surgery and saw his weight fall from 470 pounds to less than 140, Kenkelen said. But this dramatic weight loss caused a number of health issues. For years, Kenkelen helped arrange for physical therapy, medical and vision care, hearing aids and behavioral health services. But once his health stabilized, the one thing he wanted to do was go on a cruise. And he did.

“His life is 100 percent better now,” said Kenkelen.

Employers and employees alike see the value of the PNP. On one hand, employers appreciate a more productive workforce. “When employees feel better, they perform better,” explained Kenkelen.

And on the other hand, employees feel grateful they have another resource looking out for them.

That’s definitely true at Osborn’s company. “I cannot tell you how many times someone has come up to me and asked where they can send flowers to our nurse,” she said.