Since the state has transitioned to using a managed care system as opposed to the fee-for-service model - used prior to May 1 - new UnitedHealthcare Missouri Health Plan CEO Jamie Bruce will work specifically with Medicaid cases to help clients navigate their health care needs.
Under traditional fee-for-service health plans, doctors and hospitals get paid for each service they perform, whereas managed care plans cap health care expenses and administer them based on the network or system associated with the selected plan.
Prior to May 1, patients were asked to select a plan that fit their health care needs and were placed with the provider of their choice. Those who missed the deadline were automatically enrolled and could later select their preferred provider.
"I want people to understand what managed care really is," Bruce said. "We provide additional services on top of what the state provides as core services."
Bruce has worked in health care programs involving Medicaid for 15 years.
In Missouri, there are 1.4 million clients in the UHC network. Under UHC, Bruce said, there are health care plans for anyone who wants coverage, but navigating the health care system - for Medicaid customers especially - can be difficult.
"Medicaid and health care is all about relationships," Bruce said. "So we ensure that we're working with providers and community organizations to help members understand how to access their health care options."
She said transportation barriers, financial crises and even disaster relief are all elements UHC can assist with, but the most important things members can do are to visit their primary care physician for well visits and remember preventive care.
"There are always opportunities to make sure that there good outcomes for our members, but getting in for that well visit will help make an impact and potentially eliminate the possibility of any big health issue that may arise later," Bruce said.
Two programs Bruce said are popular within the UHC network is the Baby Blocks program for pregnant women and the Airways program for clients with asthma. Both programs provide incentives to members by keeping them engaged and aware of appointments they may need to keep tabs on.
"I enjoy working directly with our members, especially in the Medicaid because it is a local approach to trying to help people with their health care needs," Bruce said. "Plus, this field is ever changing."
In August Bruce plans to collaborate with a local community partner in Jefferson City to present the Nerf Energy program for children.
The event will give school-aged children a Nerf ball and a gadget that tracks their energy levels. By downloading an app on their phones, they can see their energy bars and the number of coins they have received associated with their levels of activity.
"We know kids are interested in technology and playing games, so we're trying to connect physical activity with the games provided," said Breanne Fritcher, public relations account executive with Page Communications.