21
February
2019
|
06:10 PM
America/New_York

Why Do Members Rate Horizon Highest in J.D. Power Survey for Member Satisfaction? It’s personal.

Summary

Empowering our members to achieve their best health is what drives each Horizon BCBSNJ employee every day.

By Thomas Vincz, Public Relations Manager


Case managers, fraud inspectors, and customer service agents all go above and beyond to provide our members with a superior member experience. It is why Horizon has twice earned J.D. Power’s award for the Highest Member Satisfaction among Commercial Health Plans in New Jersey.

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There’s no better example of how we work with our members and their doctors to improve health care quality, affordability and member experience than our Case Management program. It provides eligible Horizon members with education, guidance and support they may need when facing a complex medical situation. Case managers help coordinate care and make sure that our members have the information and tools to deal with their illness or condition so they are on the road to recovery as quickly as possible.

Members dealing with health issues such as a high-risk pregnancy, a newborn with medical problems, a cancer diagnosis, heart surgery, an organ transplant, or those in need of ventilator management, extensive home care, home infusion can all benefit from the services provided by case managers.

Pat*, a member who recently took part in the program, is a pediatric nurse with more than two decades’ experience. While she has extensive knowledge of pediatric nursing, she felt like anyone else when she received her cancer diagnosis.

“I don’t have a lot of (professional) experience with oncology. I really had no one I could turn to,” explained Pat, who was searching for details about her condition, treatment options and health insurance benefits. “Cheryl really called me at the perfect time.”

While still in the hospital following surgery, Pat was contacted by Cheryl O’Blek, a registered oncology nurse who serves as a Case Management specialist for Horizon members diagnosed with breast cancer. During that initial call, and through weekly check-ins with Pat as she underwent chemotherapy, surgery and recovery, Cheryl offered her timely information, advice, and encouragement that helped her through her journey. Cheryl also made sure that the many health professionals involved in Pat’s care worked together, shared important information, and made sure that Pat was treated like a person, not a diagnosis.

“Even with my expertise as a nurse, I could still use the guidance of an expert,” Pat added. “Cheryl really hit the nail on the head with everything. She gave me peace of mind.”

The free Case Management service is provided by trained Care Managers, who are fully licensed health care professionals and registered nurses. They work with the patient and treating doctor to ensure the member has access to the best care possible. The managers also assist in helping members understand how to maximize their plan benefits and minimize out-of-pocket expenses.

According to Cheryl, an oncology nurse for 19 years who joined the Horizon team in 2017, the program is designed to guide patients to effectively deal with their medical crisis. “By educating them on their options and available resources, we help patients become better self-advocates,” Cheryl explained. “But we strive to go beyond the clinical information and provide them with emotional support, too.”

Cheryl works exclusively with breast cancer patients, and typically supports 90 to 100 at any time. She finds the work rewarding. “When I tell people I’m an oncology nurse, people will say ‘that’s so sad.’ But I think it’s just the opposite. We’re making a personal connection to guide patients through their journey to survival.”

That was certainly the experience of Pat, who valued Cheryl’s knowledge and compassion. “You can tell if someone is just reading off the sheet or going through the motions. Cheryl really listens to you.”

How to enroll

Eligible Horizon BCBSNJ members may enroll themselves or an eligible dependent in the Case Management Program by calling 1-888-621-5894 and selecting option 2. Representatives are available for assistance Monday through Friday, from 8 a.m. to 5 p.m., Eastern Time. If you have hearing or speech difficulties, please call the TTY/TDD line at 711.

Members can also be referred to our Case Management Program from other departments at Horizon BCBSNJ, including our Utilization Management department and Chronic Care Program department, the 24/7 Nurse Line, as well as rehabilitation facilities, facility discharge planners, behavioral health providers, practitioners, caregivers and pharmacy vendors.

*At the patient’s request, we have used a pseudonym to protect her privacy.