How One Health Plan Is Improving The Whole Health Of Its Members

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Headquartered in Andover, Mass., UniCare is a health benefits company that administers healthcare benefits for nearly 200,000 Massachusetts state employees, retirees, and municipal employees insured by the Commonwealth of Massachusetts Group Insurance Commission (GIC). Patch had a chance to talk to David Morales, the general manager of UniCare, about how the company is working to improve whole health and what that means for its members and the community.

How long has UniCare been in business?

UniCare has been serving Massachusetts state employees, retirees, and their families for more than 30 years.

What is the difference between UniCare and the Group Insurance Commission?

UniCare is a private company that provides health benefits for GIC-eligible employees and retirees. What that means is, the GIC sets policy for claims, payments, and plan design and UniCare administers the health benefits, customer service, and claims as well as manages four health benefit products.

How does UniCare distinguish itself from other health insurance companies?

UniCare is the only indemnity plan offered by the GIC, which means all of our plans give members the freedom to see any doctor or healthcare provider without a referral. Members can get the care they need almost anywhere, depending on which plan they choose.

In addition, UniCare is the only health plan that provides benefits exclusively to individuals and families insured through the GIC. We have no other customers, meaning we focus all of our efforts on providing our members the best service possible. Our member satisfaction rates are consistently over 90 percent and we take great pride in developing solutions to best support our members’ whole health.

What exactly is “whole person health”?

For years, healthcare only centered on addressing part of the picture – what’s “broken” – by focusing treatment on physical illness, injury, or symptoms (what we call sick care). But health is much more than your physical well-being – it encompasses your mental, emotional, and social well-being as well. In fact, numerous studies have shown that 80 percent of health is determined by what happens outside the doctor’s office, also called social drivers of health. These social drivers include where we live, our ability to access healthcare and nutritious food, our ability to secure a steady income, and community support. Identifying individual social needs and connecting people to the most appropriate support resources can help improve health outcomes by reducing barriers or addressing problems before they become a health issue or crisis.

How is UniCare improving whole person health?

We know healthcare needs to be a lot more personal and a lot more oriented around individual social needs. So at UniCare we’re supporting our members’ health through a unique combination of total access to providers, personalized care support, and powerful digital health tools. Our Whole Health, Whole You program provides care for members in need of highly personal, complex health services. Case managers coordinate care across a team that includes nurses, dietitians, respiratory therapists, pharmacists, exercise physiologists, and health coaches. All members have access to integrated behavioral health services. UniCare also employs a social worker to connect members to needed social services and community resources.

What sort of features should individuals look for in a health plan?

For anyone picking a health plan – because we all have to do it at some point or another, whether it’s as a GIC member or via the insurance coverage you get from your employer – it’s important to really take the time to compare different plans and determine what works best for you and your family’s health needs.

First, think about your own health and that of your family – are you generally healthy, or do you have a chronic condition that may require regular care or access to specific doctor? Another factor to consider is where you live year-round and how often you travel. In addition, think about which hospital you prefer to use – if you need care, do you want to be able to use different hospitals, or do you tend to get care close to home if it’s not an emergency? And finally, cost is a critical factor. How much can you afford to pay in premiums every pay period, and what kind of out-of-pocket costs could you expect with each health plan?

Are there any new projects or endeavors you're working on that you're extra excited about? If so, what details can you share and what makes it so exciting?

I’m really excited about empowering our members on their individual health journeys. Our digital tools give our members access to personalized care right in their own home. Members can access telehealth services, check their claims, or find health tips through our Sydney Health app. And just recently we introduced a new offering to members, an at-home medical exam kit from TytoCare that’s available a discounted rate from what you can buy via retail at stores. The kit consists of a mobile app and the TytoCare device, which lets a doctor remotely check your heart, lungs, abdomen, ears, throat, skin, heart rate, and body temperature. With these concrete readings, a doctor can easily diagnose and treat many common ailments – care on your time and in your own home. Our goal is to enable our members to take a proactive role in their health journey and make healthcare easier.

How can Patch readers learn more about UniCare?

Readers can visit unicaremass.com or follow us on social (@UniCareMA) to find health tips or learn more about us.

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