Case managers and peer support staff working in the health insurance industry assist clients with a wide range of conditions and chronic diseases in navigating the complexities of the healthcare system. About 60% of adults in the U.S. have at least one chronic disease, and 40% have two or more, according to data from the Centers for Disease Control. Their roles become even more challenging when conditions outside of physical medical concerns, behavioral health issues like mental health and substance use disorder (SUD), factor into the equation, which, with nearly 17% of the U.S. population aged 12 or older reporting SUD in the past year, they often do.
In addition to complicating the care path for members, managing SUD along with chronic conditions and more common health events like pregnancy is costly. It is estimated that SUDs cost employer health insurance plans $35 billion per year, about $26,000 per person with an SUD diagnosis—and that is just for SUD alone, without other health conditions.
As a result, health insurance plans have a strong interest in cost-effective tools that aid their teams in providing support for individuals with SUD. CHESS Health’s Connections app, part of the eRecovery solution, is designed specifically for this purpose, providing critical 24/7 peer support, moderated discussion forums, educational resources, virtual support meetings, daily check-ins, and crisis response for individuals with SUD. At the same time, the app assists case managers and peer support teams by simplifying their communication with members, filling the gaps in support that occur between appointments and after office hours, and delivering a streamlined way to measure client progress.
Case managers and peer support staff at one specific health insurer with the Connections app described the reasons they encourage their members to engage with Connections and the multiple benefits they receive when their members participate.
Many physical and psychological barriers stand between people with SUD and recovery. Individuals might live in an area without nearby options for treatment or meetings, or they may feel the burden of stigma and anxiety about sharing an SUD diagnosis. Having an app available right on their phones that they can access in the privacy of their own homes using a screen name helps put people at ease, allowing them to open themselves up to recovery support.
Katie, a wellness and recovery specialist at the health insurer, suggests that her members log on to Connections and explore, even if they don’t choose to engage right away. “A lot of members that I deal with have anxiety about going to meetings,” Katie said. “I can encourage them to hop into a meeting and tell them not to turn their camera on. Just be present and listen to someone else share until you’re ready.”
Katie works for a program that focuses on women between the ages of 18 and 40 who are at risk for, or have, an SUD diagnosis. Her goal is to set them on a path to healthy lifestyle choices, but her interactions with them are brief. It’s typical for her to engage with a member only one time, so telling them about the Connections app and helping them get set up is one of her top priorities.
“I love the fact that I can connect them with Connections and know they’re going to get that ongoing support,” she said. “I feel really good about what Connections has to offer in terms of peer support and different kinds of (virtual) meetings. And the 24/7 access is huge.”
Knowing that an experienced peer support team covers members provides an extra layer of comfort for the insurance team staff, especially when they’re working with a member who has immediate needs. “If I can tell that someone is struggling and I know I’m only working with them on one phone call, the handoff to a CHESS Health peer is critical,” said Ashton, a coworker of Katie’s.
Recently, Katie took a call from a woman who had been sober for just a few weeks. Katie encouraged her to download the Connections app and followed up with her a few days later just to check in. The woman took Katie’s call and told her that she was on the other line with a CHESS Health peer engagement specialist at that exact moment. She needed help and found it through Connections. “That showed me the support and how much they reach out to members,” Katie said. “I felt really good about referring that member to Connections.”
Many members have privacy concerns, so they appreciate that Connections is HIPAA compliant. They’re also relieved when they realize they can go to meetings virtually and anonymously, said Natalie, an outreach care specialist at the insurer. When people live in small towns or rural areas, it can be challenging to access necessary care and support without others being aware. “People are excited about that,” she said.
Tiffany, another wellness and recovery specialist at the insurer, said a member told her how grateful she was that she accepted a call from her insurance company, because on that call she learned about the Connections app. “She was expressing how she had been trying to find groups to help her and she was so glad she had taken the call,” she said. “I always tell members that the [CHESS Health peer engagement specialists] staff are completely amazing, ready to reach out and help anyone in need.”
The experiences shared by the health insurance team demonstrate the impact that accessible, digitally delivered peer support can have on both members and the professionals who serve them. As costs continue to rise and demand for SUD care remains strong, solutions like the Connections app offer a powerful way to bridge gaps while providing the privacy, convenience, and availability that people in recovery need most.
For health insurance plans seeking to enhance member outcomes while effectively managing costs, investing in digital recovery support is a smart business decision. When staff can confidently connect members to proven peer support resources, everyone benefits. Members receive the care they require, health insurance teams can focus their expertise where it is most needed, and health plans realize improved outcomes without excessive costs.
Partner health plan and staff names withheld for confidentiality.
