Most times when we hear health and wellbeing we attribute it to our physical state, but wellbeing is more than just getting a step count in for the day. Wellbeing is the state of being comfortable, healthy and happy. This can come in many different forms and doesn’t look the same for all. Your employees have daily experiences that change the way their wellbeing is impacted so it’s important to reflect on meeting each individual where they are in their unique wellbeing journey. Different Types of Wellbeing: Physical Wellbeing – The ability to carry out daily tasks without discomfort and improve the functioning of your body through healthy living and good exercise habits. Emotional Wellbeing – The ability to handle emotions, adapt to difficult times, and create emotions that lead to better feelings. Mental Wellbeing – The ability to think clearly, make good decisions and cope with life stresses. Financial Wellbeing – The ability to become financially literate and be in control of your money and resources. Connecting Wellbeing and Health Equity Health is largely determined by our circumstances and environment – is there access to green spaces or healthy food nearby? A stable home life? Some other key influences can include income, accessibility to care, educational attachment and relationships. These external factors are known as Social Determinants of Health (SDOH).Populations who experience higher rates of SDOH challenges can also see increased rates of mental health disorders. While these marginalized groups bear a high burden of disability, barriers to care, such as stigma, mental health workforce shortage, and geographical maldistribution of providers keep individuals from receiving the mental health care often needed. The National Institutes of Health reported that racial-ethnic minority groups are 20%–50% less likely to initiate mental health service use and 40%–80% more likely to drop out of treatment prematurely. There is also growing evidence to show that the mental health services available to LGBTQ+ individuals are often scarce or inadequate in the specialized care needed. Due to these gaps, it’s important to change the narrative around mental health and reflect on what tools and resources you are providing your team to get the support they need. Similarly, how is your current wellbeing strategy addressing those with physical disabilities? Many traditional wellbeing programs focus on the physical ability of the individual either getting a step count in or getting to the gym. The CDC reports, though, that more than 1 in 4 US adults 18-64 years of age has a disability. These disabilities can include difficulty walking or climbing stairs, hearing, concentrating, remembering or decision making. This leads a whole group of people to be unengaged in their health and wellbeing. These examples help illustrate the importance of having an inclusive wellbeing strategy for your team that creates fair opportunities for all members to live a healthy life. Health equity can only be achieved when all employees are able to live their healthiest lives. Wellbeing for All is Now Within Reach We are proud to introduce a new 2024 benefit called Vitalize℠, powered by Virgin Pulse*. A digital platform that places the power to live better at Western New Yorkers’ fingertips. Western New Yorkers work hard. That’s why accessing the resources needed for all aspects of health should be easy. At Univera Healthcare, we’re here to provide technology that empowers your teams to take control of their health. We’re talking about tools for engagement, rewards for prioritizing a healthier lifestyle, and support for overall health and wellness. Within the platform employees will have access to: A variety of wellbeing content for everyone Specific actions to address Social Determinants of Health Coaching that supports everyone in your community Channels that reach and engage Assistance and guides to navigating the complex health care system Science that changes behaviors We will also be offering Vitalize Rewards** that goes beyond just rewarding physical health. Employees will have the opportunity to earn points by doing healthy things like: Tracking sleep nightly Tracking Healthy Habits 20 days in a month Setting a wellbeing goal Completing a Journey And so much more! It’s a different approach to caring for your workforce and ensuring better health and financial outcomes. Because that’s exactly what your business deserves. Let’s Empower Your Team to Take Control of Their Health. See what having wellbeing for all, all in one place, can mean for your business and your employees. To learn more about how Vitalize can support your employees, talk to your broker or Univera Healthcare account manager today. You can also download our large group employer brochure or our small group employer brochure to learn more about the program offerings. * Vitalize is embedded for all Fully Insured group plans with the exception of Minimum Premium arrangements. Buy-up option available for Minimum Premium and Self-Funded group plans. Subject to DFS approval. **Vitalize Rewards are embedded for all Small Group plans and buy-up for all Large Group plans.

In our ongoing efforts to ensure access to high quality, affordable health care and reduce costs. Univera Healthcare leads the insurance industry in pursuing biosimilar drugs for our members.

We are proud to introduce a new 2024 benefit called Vitalize, powered by Virgin Pulse. This digital home base is dedicated to engaging your team in health and wellbeing. Download this brochure to learn more about how Vitalize can support a more complete approach to wellbeing for all your employees.

We are proud to introduce a new 2024 benefit called Vitalize, powered by Virgin Pulse. This digital home base is dedicated to engaging your team in health and wellbeing. Download this brochure to learn more about how Vitalize can support a more complete approach to wellbeing for all your employees.

Learn about Site of Care, a program that provides important options for members who are receiving infusion drugs at high-cost facilities.

From comprehensive plans and great extras to excellent service and satisfaction scores, see what's to love about working with Univera Healthcare for your employee health coverage.

Employees face barriers to care that can impact their ability to live as healthy as possible. This toolkit includes ideas for how your business can make a difference and a handout for employees who may need extra help.

Learn how the Pharmacy Concierge program focuses on controlling cost by driving appropriate utilization of medications while ensuring members are benefiting from clinically appropriate therapies.

How do barriers to care impact employees and businesses? Health Equity. This concept has been studied since the early nineteenth century by people involved in public health, sociology, and political economics.1 It’s also near and dear to our mission as a local not-for-profit health plan in Western New York. But only recently has it started to gain a stronghold in mainstream culture and captured the attention of well-intentioned individuals and businesses alike. We’re all growing more and more aware of the health disparities that face people right here at home and across our country. Health equity is achieved when every person has the opportunity to achieve their full health potential – where no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Health disparities can be defined as preventable differences in the burden of disease, injury, or violence, or in opportunities to achieve optimal health, that are experienced by socially disadvantaged racial, ethnic, LGBTQIA+, and other population groups and communities. In other words, there are factors largely beyond a person’s control that act as barriers to optimal health and health equity – meaning they make some people more susceptible to poor health outcomes. 80% of health outcomes are estimated to be impacted by social determinants of health.7 We are working diligently, along with others in the health care and welfare community, to dismantle systemic structures that have supported a legacy of inequities that continue to negatively impact the health of Americans, especially people of color. Eliminating the barriers to optimal health requires partnership between organizations to address racism and the impact of social determinants of health. The impact of these barriers extends beyond the just the individuals burdened by them, including businesses. Health disparities result in an estimated $93B in excess medical care costs8Racial health disparities cost employers an estimated $42B in lost productivity per year.9 What barriers do employees face? Let’s take a minute to think about the diversity of employee populations. Some have college degrees, others only high school diplomas or on-the-job skills training. One person might be the primary earner at home, while another has a partner contributing to the household income. And maybe they work one full-time job, or multiple part-time jobs to make ends meet. Some own a home in a quiet suburban town, while others might rent in an urban or rural neighborhood that has faced systemically low investment or divestment. How many own a car versus rely on public transportation, and how close do they live not only to work but to quality, affordable health care and food options? Who faces discrimination, hate and even violence on a daily basis due to where they live or how they identify? Many probably speak English as their first language, but there are some who don’t and will struggle to find a mental health provider who speaks their native language so they can adequately and easily express their nuanced needs and have them understood. Every business is likely to have employees facing at least one barrier to optimal health, such as: Racism and ethnic discrimination Discrimination due to sexual orientation and gender identity Safe housing, transportation, and neighborhoods Violence Education, job opportunities, and income Access to nutritious foods and physical activity opportunities Polluted air and water Language and literacy skills If we look at the populations within our local Univera Healthcare service area, we can see evidence of this right here at home. For example: 5% (which equates to more than 76,000 people) of the Western NY region’s population is Black.2 Among other things, we know that Black Americans tend to have a lack of trust in the health care system and are less likely to have a primary care physician and receive preventive services, leading to poorer health outcomes.3 At least 1 in 10 New Yorkers experience food insecurity, with food-insecure New Yorkers being twice as likely to report unsatisfactory health.4 In our service area, we have counties like Chautauqua, Cattaraugus, and Allegany with nearly 14% of people facing food insecurity. New York state has the second highest Asian American population in the U.S., with 30.9% of Asian Americans nationally not fluent in English.5 Language barriers can lead to delays in accurate diagnosis and gaps in care.6 Nearly 360,000 people—almost 25% of the total population—live in rural communities within our local Univera Healthcare service area.2  Rural residents face issues like physician/provider shortages and far distances to access services, limited access to healthy foods, and higher smoking rates than their urban counterparts. And the list goes on. Our members—and your employees—are diverse in where they live, their education and income levels, race, gender identity and sexual orientation, and more. All of which impacts their ultimate health outcomes in one way or another. These barriers have an impact on not only their health, but also other aspects of their life, including work. They might miss work frequently due to things like lack of transportation, lack of safe, stable housing and childcare, unaddressed or poorly managed health needs, or caring for aging parents. When they are at work, their productivity might be lower with life concerns weighing on their mind. And financially, they’re facing excess out-of-pocket medical costs because they have put off getting the care they needed for too long. 24% of employees with health insurance are considered “underinsured,” meaning these employees have coverage but not the financial resources to afford their plan’s out-of-pocket costs.10 It's also important to recognize how removing one barrier might positively impact another part of a member’s life. For example, if you help a member, Mary, with access to transportation, she can now make it work reliably, make it to her doctors’ appointments, and can make it to the grocery store regularly. Mary’s life is positively impacted, her health is positively impacted, and her productivity at work is positively impacted. Working towards greater health equity is our mission in action At Univera Healthcare, health equity is engrained in how we help our members and groups see better outcomes, lower costs, and greater peace of mind. Our multidimensional health equity strategy centers around engaging, educating, and empowering our members, employer groups, and the community in order to break down these barriers to optimal health. When we don’t have health equity, this costs everyone: members and their family, our health care system, and employers in terms of untapped productivity or excess medical costs.  When we work together to address barriers and expand access to care in the community, members can see improvement in their daily lives, are more productive at work, and contribute more to their communities. Resources you can use To learn more about what Univera Healthcare is doing to remove barriers for our members, download our Health Equity Brochure. To learn how businesses can help promote health equity and empower members to seek help, download our employer toolkit. To learn more about what Univer Healthcare is doing to remove barriers to care specifically for our Small Businesses in 2024, watch this short video. Sources: 1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792226/#:~:text=The%20concept%20of%20health%20equity,since%20the%20early%20nineteenth%20century. 2US Census Bureau 3https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans 4https://nyhealthfoundation.org/wp-content/uploads/2023/01/NYHealth-survey-of-food-and-health.pdf 5U.S. Department of Health and Human Services Office of Minority Health, Accessed February 2023 6https://www.sciencedaily.com/releases/2011/01/110120151638.htm 7https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/ 8Ani Turner, The Business Case For Racial Equity: A Strategy For Growth, Altarum/W. K. Kellogg Foundation, July 24, 2018. 9Ken Alltucker, “U.S. Doctor Shortage Worsens as Efforts to Recruit Black and Latino Doctors Stall,” USA Today, June 26, 2020. 10https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca

At any age, having a primary care provider (also called a PCP) is important to good health. With this ready-to-send email, PCP checklist, find a doctor tool fact sheet and e-book, you can encourage your employees to find a provider and stay ahead of illnesses.

With this collection of information flyers, FAQ and ready-to-send email, you can encourage your team to activate their telemedicine accounts and stay ahead of disruptive illnesses.

At Univera Healthcare, we know that a person's ability to be as healthy as possible is impacted by more than just what happens in the doctor's office. Download this brochure to learn about the work we are doing to break down barriers to care for your employees.

Exhaustion. Irritability. Trouble concentrating. Emotionally detached from work. These are all signs of burnout, and many employees can relate to these feelings. This handout can help give employees effective strategies to build resiliency, which helps when it comes to navigating stress and avoiding burnout.

Mental and emotional wellbeing affects every aspect of life, from personal relationships and physical health to the ability to get the job done. Download our toolkit for resources that will help you and your employees with a little extra support.

Employers today are placing an increased focus on the mental and behavioral health of their workers. As a society, people are discussing issues like depression and anxiety more openly and acknowledging how important it is to ask for help. At the same time, advances in technology and changes to health care delivery are making it easier to address mental health concerns and provide a more holistic approach to care. As a society, we’re talking much more about emotional health than ever before. What was once a taboo topic and a sign of weakness, is now discussed openly. The Impact of Emotional Health In the U.S., mental health and substance use issues cost businesses $80 to $100 billion each year.1 And even though over 200 million workdays are lost due to mental health conditions annually ($16.8 billion in employee productivity), it remains a difficult subject for many people to discuss. Almost 60% of affected employees have never spoken to anyone at work about their mental health status.2 Today’s workforce demands a more open culture when it comes to emotional health, especially now with the effects of COVID-19 being felt across society. Employees need an approach that doesn't just focus on mental or physical health, but on the entire person. A Holistic Approach to Care Guiding individuals to proper care means looking at all aspects of their well-being – physical and emotional – and meeting them where they are. And it starts with addressing some of the common challenges. Health care is a complex industry. Most employees don't encounter this complexity until they're in the middle of a crisis trying to navigate the system. That’s why it’s important to have a health insurance provider that can surround them with care, support and solutions that are holistic and work for them. Being able to connect with the right care professionals, including nurses, care managers, pharmacists, wellness consultants and more, is critical for an individual’s overall health care journey. By connecting employees with resources to help them lead healthier and more secure lives, you can enable them to not only manage disease, but also prevent it. New Ways to Provide for Your Workers For many people, nothing will replace a heart-to-heart conversation. Having access to a 24/7 nurse line can provide emergency resources to individuals in need along with the reassuring comfort of an actual voice on the other end of the line. But just as attitudes toward mental health are changing, so are the delivery methods for treating people. When it comes to emotional health, sometimes it's easier to communicate remotely. Speaking by video or texting with a doctor or therapist can feel more private and is now easier than ever. That's why the importance of telehealth services for both physical and behavioral health has increased dramatically during the coronavirus pandemic. In addition to telehealth, some insurance providers now offer care management apps that members can access from their smartphones or tablets. Through apps like Wellframe, provided by Univera Healthcare, case managers can assist members in managing medications and connecting with other resources for answers to health care questions — providing a holistic approach to health and making care easier to manage. The app has an emotional health care component with a 30-day Behavioral Health & Wellness Foundation program, covering general emotional health, wellness, and prevention topics. Today’s workforce demands a more open culture when it comes to emotional health, especially now with the effects of COVID-19 being felt across society. Employees need an approach that doesn't just focus on mental or physical health, but on the entire person. Where Do We Go From Here? We're entering uncharted waters. The only certainty is that this generational pandemic will have lasting impacts on all of us. On our physical health, our financial health, and our mental health. Providing a synchronized approach to physical and emotional health, and getting the right tools, programs, and support into the hands of those who need it most will help make a difference. Learn more about Univera Healthcare's Wellframe app and supporting your employees' emotional health →

With depression and anxiety topping the list of the most common conditions for employer groups, many organizations are looking for ways to make workplace wellness a part of their company culture. To support workers and improve the ability to attract and retain the best talent, employers today are providing everything from mental health resources and stress management tools to education on mindfulness and meditation. When implemented thoughtfully, these programs can have a positive impact on employee wellbeing and engagement. Employees who strongly agree that their employer cares about their overall wellbeing, in comparison with others, are:69% less likely to actively search for a new job71% less likely to report experiencing a lot of burnout3x more likely to be engaged at workGallup, February 2022 But with today’s tight labor market, how can you make sure your wellbeing strategy will work for your employees and your business? It all starts with data As a Workplace Wellbeing Consultant for Univera Healthcare, I’ve helped many businesses develop and implement wellbeing strategies. One of the first steps I always recommend to employers as they start the process is to gather data on the unique needs of their employees. There are many ways to collect the data you need, including conducting employee interest surveys, analyzing claims data, and looking at industry trends. This data will help you decide what strategies will provide the most value for your organization and will give you insights that can be used to develop relevant and engaging programming. Get set for success Before your company officially kicks off its new wellbeing program, think about what your team will need to succeed. You might want to start looking for toolkits and training programs to help prepare wellness committee members prior to launch, as well as additional materials to help keep the program fresh for employees. Start brainstorming and collecting helpful resources like monthly wellbeing tips, topics for health education programs, and challenges that can keep employees engaged. Make healthy connections To maximize the value of your wellbeing strategy, you want to make sure employees understand all the resources available to them and feel motivated and empowered to use them. A good way to achieve this is by leveraging relationships with vendors and the local medical community, and by tapping into your employee health benefits. For example, with the businesses we support, we bring in experts from within our organization to host educational sessions on resources available through their health plan. This includes benefits like telemedicine and care management programs for behavioral health, and a 24/7 nurse line. You should also consider connecting with local medical resources to help ensure health is a top priority for your team. That could mean bringing in vendors for on-site biometric screenings, encouraging employees to schedule annual visits with doctors, or reaching out to local medical professionals for specific expertise based on the needs of your team. Greater wellbeing makes your whole business stronger Supporting the wellbeing and mental health of your employees will continue to be a critical objective in today’s evolving workplace. Not only can it help attract and retain the best talent, it can also help unlock the full potential of your workforce by improving collaboration and morale, leading to better engagement and improved results. Jeannette Kreher Heberling, Project Manager and Partner at Kreher Family Farms, leads one of the wellbeing programs we support. As her company’s dedicated Workplace Wellbeing Consultant, I collaborate with her and her wellness committee, as well as their broker, to develop monthly themes and to make sure the right resources are always available to their team as they continue to grow their program. Our experience with Univera Healthcare's workplace wellbeing programs has been so positive. Our team really enjoys the programs, and it's been amazing seeing the impact on both their physical and emotional health, especially throughout COVID-19. Jeannette Kreher Heberling – Project Manager and Partner, Kreher Family Farms I encourage you to take the next step toward developing a wellbeing strategy that works for your organization. By understanding the needs of your employees and providing access to the right resources, you’ll be that much closer to creating a thriving workplace where employees feel motivated and empowered to do their best work. Check out univera.phgtestsite.com for a library of free resources you can download and share with your team.

Caring for your people isn’t something you only do from 9 to 5. So in this 24/7 world we’re helping you help employees manage their health each and every day with the Wellframe® app.

The flu is a contagious respiratory disease that can lead to hospitalization and even death. Because of COVID-19, it’s even more important to do everything you can to keep yourself and your family healthy this flu season.

If you’ve never had a high deductible health plan (HDHP) it can take time to get used to how it works. We want to help you feel confident when using your Univera Healthcare plan and have assembled information to help get you started.

According to the American Dental Hygienist Association, nearly 75% of American adults have some form of gum disease and don’t even realize it. Here are a few more reasons not to skip that next checkup.

Investing in employee wellness is just good business.

In this toolkit file, you’ll find resources to help you provide a safer and healthier work environment for your employees. All recommendations and guidelines come directly from the Centers for Disease Control and Prevention (CDC).

Check out the Get Started guide and Ready-to-Send emails for employees. With an online account, your employees can view benefits, claims, member cards, and more.

This toolkit will help you and your team get to know our comprehensive Diabetes Management Program and all the ways it can help your employees better manage their diabetes, save money and enjoy more peace of mind. This program leverages tools like the Wellframe(R) App, our Member Care Management team, and Remote Monitoring.

If an employee is losing their employer-sponsored health insurance or if some of their family members aren't covered by the group plan, you can help them understand the affordable, high-quality options that are available. 

In this toolkit, you’ll find resources to help your Medicare-eligible or soon-to-be-eligible employees understand how Medicare and Medicare Advantage plans work so they can select the coverage that’s best for them.

Everything you and your team need to know about our Maternity Care Program and its individual program components. Note: Some program components are included at an additional cost for some funding arrangements.

This employer brochure will help you get to know how our comprehensive Diabetes Management Program leverages tools like the Wellframe(R) App, our Member Care Management team, and Remote Monitoring to help members better manage their diabetes.

The Calm® app helps members build resilience through better sleep, mindfulness, and meditation—and it's included in all Fully Insured Large Group medical plans (included in Small Group plans beginning 2023). The Calm e-book includes resources such as registration instructions, sample HR email template, member FAQs, links to additional Calm resources, and trainings.

Exploring ways to address and reduce work-related stress. The COVID-19 pandemic triggered one of the most significant changes to the workforce in generations, shifting the workplace for many of us from conference room to living room practically overnight. This “new normal” has had a transformational impact on the work experience, bringing change not only to where we work, but how we work: making adjustments to work roles, schedules, routines, and priorities. These changes can lead to added work-related stress, and ultimately burnout. A recent study by the employment website Indeed found that two-thirds of workers surveyed said the pandemic has worsened employee burnout. When stress gets to be severe enough, and we have depleted our internal resilience, we can develop burnout. Identifying burnout Burnout is a series of experiences that occur in relationship to workplace stress. These burnout experiences in the workplace can be seen through increased absenteeism, increased use of sick leave, decreased productivity, and, eventually, leaving the workplace altogether. How burnout happens There are several circumstances that can lead to employee burnout. Some of the most common include: Excessive workload: The most basic way burnout occurs is when there is a mismatch of the demands at work and the resources employees have. Most of the time, that resource is time. Being asked to do too much, too quickly can be one of the root causes of burnout. Lack of control: If a team member doesn’t feel they have any ability to claim some control over their work, that’s another root cause of employee burnout. Lack of community at work: Humans are social beings. One of the worst things that can be done to a person is cutting them off from their social connections. Work is where individuals spend most of their waking lives. If an employee's workplace is hostile, or they feel separated from work, or are working remotely and don’t do extra things to build community, that can lead to the development of burnout. Additionally, if an employee feels discrimination or intimidation, or doesn’t have the ability to reach out to get help or assistance, that can be a cause as well. Lack of recognition or reward: Individuals like positive reinforcement and recognition of accomplishment. Without this, it is a sure-fire way to experience burnout. Mismatch of values: Individuals seek value in where they’re working and want to feel that they’re making a difference. If their values don’t resonate with those of their workplace, they can feel detached, which can lead to burnout. Work is inherently stressful. Fortunately, there are strategies to help employees build resiliency and prevent stress from progressing into burnout. Strategies to build resiliency Resiliency is being able to adapt to unforeseen and stressful situations. If we’re nurturing our resiliency, we can bounce forward from stressors more easily. Although it’s an extremely effective tactic, we’re not all born knowing how to do it. It is a learned skill. Think of resiliency as a series of activities and mental attitudes that can improve over time, allowing us to better withstand stress. It takes intentionality, time, and repetition to master. Here are five general strategies to help employees improve personal resiliency. Focusing on employee wellbeing Employee burnout is a reality employers can’t afford to ignore. Employee engagement, productivity, and growth are never sustainable without a focus on employee wellbeing. Employers are doing a lot to address burnout and help cultivate a mentally healthy workplace. Many are increasing their support of mental health services and have enhanced or implemented workplace wellbeing programs. They’re resetting working practices such as urging employees to set boundaries and work regular hours, encouraging vacations, or instituting company-wide wellness initiatives. At Univera Healthcare, for example, we have a variety of wellness programs and resources for our employees. We provide free virtual fitness classes and regularly scheduled wellness challenges, and our wellness team hosts virtual webinars, Lunch and Learns, and “live” video coffee chats. When employees are engaged, burnout decreases, and productivity and wellbeing increase. Another way you can help your employees avoid burnout: Share our Health and Wellness resources with your team for information on health tips,access to fitness videos, and more.

This toolkit makes it easier for you to educate your employees on the importance of breast health and encourage them to be vigilant in staying a step ahead of breast cancer.

With emails, a quick-start guide and more, you'll have everything you need to get employees on their way to better health with the free Wellframe app.

Help employees know what to expect at an eye exam, tips for supporting good vision and healthy eyes, and a guide to eye health specifically for employees with diabetes.

Pharmacy Concierge brings big savings for a minimal investment. And the savings are guaranteed. There is nothing to lose.

New York State is now conducting annual eligibility reviews and renewals for members enrolled in a free or low cost New York State sponsored Safety Net plan. Learn what this might mean for your employees and what their options may be.

High-quality, affordable health care for all is a goal everyone can identify with. It’s a critical issue in our nation today, as it impacts all of us, including people with serious and chronic health conditions and those fortunate enough to enjoy excellent health. But the reality is health care in the U.S. today is complex, often difficult to navigate, and expensive. A recent Kaiser Family Foundation poll found that 58% of Americans are worried about having to pay unexpected medical bills and close to half of all Americans are worried about paying their health insurance deductible and prescription drug costs1. High costs impact health. Some 29% of Americans report not taking their medicine as prescribed because they could not afford to pay for it2. While there are no simple answers, having medical and pharmacy benefits fully integrated is a critical step in the right direction. We firmly believe that integration is safer for members, easier for employers to manage, results in improved health care, and costs less overall. Clinicians See the “Whole Picture” With Integrated Benefits Let’s start with the basics. Integrated benefits mean a member’s health coverage and pharmacy coverage are provided by the same health plan. The pharmacy benefit is used more than any other benefit in a health plan. When medical and pharmacy benefits are integrated, a clinical team sees the “whole picture” of a member’s health. Data is accessible in real time. Integration enables a care manager to see a member’s claim before speaking to them, or a utilization review pharmacist to see a member’s prescription claims when reviewing a prior authorization for a medication. This saves time, which can be critical in a medical situation, and also means that our clinical team has all the information needed to advise on medical questions and concerns. We’re passionate about integrated benefits because we see firsthand that healthcare works best as a team effort -- when medical and pharmacy teams collaborate, medication adherence is improved, patients experience better health outcomes, and emergency room visits and even hospital admissions are reduced. Why A Team Approach Works Best To illustrate the importance of integration in medicine, we can look to diabetes as an example. Diabetes is prevalent in the U.S., affecting over 10% of the population. The number jumps to 29% in people over the age of 65. When a person with diabetes who has integrated benefits shows up at an emergency room, the health plan’s care manager is able to access medical and pharmacy data in real time. Did the patient miss a recent medical appointment, or fail to pick up their prescription? Is the patient taking advantage of educational programs on their health condition? Would remote glucose monitoring by a pharmacist be helpful? Are there any gaps in care? A collaborative team approach can help the patient adhere to their prescriptions and perhaps get extra support from a nutritionist or social worker. The clinicians work together towards two goals – a better health outcome for the patient, and the prevention of future emergency room visits. Without integrated benefits, a patient’s care is likely to be fragmented. There is a medical chart and prescription data, but no clinical team who can see the whole picture, in real time. Beyond Better Health Outcomes, Lower Costs3 Integrating medical and pharmacy benefits leads to real savings, for both the employer and the individual member. In our experience, overall medical costs are 4-6% lower when the pharmacy and medical benefits are integrated. Here are three key areas where integration is key: Emergency Room visits account for an estimated $8.3 billion in spending each year in the U.S. When clinical teams have a full picture of each member’s health story, including physician visits and medication regimens, many types of ER visits can be avoided, saving money, time and worry for patients, and preventing patients’ exposure to other illnesses. Integrated benefits result in 17% fewer instances of all unnecessary ER visits, at an average cost of $1,695 per visit3. Chronic conditions, such as diabetes, heart disease and depression, account for $1.1 trillion in health care costs, and $2.6 trillion in lost productivity each year in the U.S. For members with diabetes, integrated medical and pharmacy benefits results in 19% fewer ER visits, with an average cost of $1,695 per visit. In addition, integration reduces preventable admissions by 13%. A hospital admission costs an average of $13,9203. Specialty Drugs are prescribed for complex, chronic conditions. They are used by only about 2% of the population but account for 50% of total drug spend. Through specialty drug management, health insurers can see both medical and pharmacy data. This means the clinical team can determine if the medication is being prescribed correctly, if the correct dosage is being administered, and ensure there is not waste3. Less Administrative Hassle for Employers, Easier for Members Employers report that having integrated benefits is easier to manage, smoother to implement, with one point of contact for any questions or concerns. Members carry one card, with one phone number. If a member needs to call for assistance, the professional responding to their call has access to both medical and pharmacy data. With integrated benefits from Univera Healthcare, employers and members have a team behind them, with 48 full-time pharmacists and 17 medical directors. These team members review claims, consult with care managers to make sure patients are adhering to their care plans and prescription regimens, monitor for drug interactions, and verify that the most appropriate medical or pharmacy drug benefit is being applied based on medical guidelines. By reviewing a member’s complete medical history, we can identify additional programs, assessments, and services the member may be eligible for. These additional programs often improve health outcomes and can lead to cost savings as well. Integrated benefits allow our clinical team to coordinate directly with the patient’s caregivers. Dedicated pharmacists and medical directors who can see “the whole picture” of a member’s health journey, can make a big difference. Contact us today to learn more about the great outcomes our team has achieved through integration and the comprehensive management programs that come with every integrated plan. Sources ”KFF Health Tracking Poll – March 2022: Economic Concerns and Health Policy, The ACA, and Views of Long-term Care Facilities”  Kaiser Family Foundation, March 2022 ”KFF Health Tracking Poll – February 2019: Prescription Drugs,” Kaiser Family Foundation, March 2019 Comparison of Book of Business integrated medical and pharmacy employer groups vs. medical-only employer groups.

The Medication Assurance Program is designed to reduce spend on specialty medications by holding manufacturers accountable for drugs that are approved through the Food and Drug Administration’s (FDA) Accelerated Approval Program.