November 26, 2024: Meet Margaret, a 47-year-old female employee in your company.

Meet Margaret, a 47-year-old female employee in your company.

How would your company’s benefits support her?

Margaret is a 47-year-old hard worker and is a valued member of her work group at your company. She’s been employed by your company for 10 years. Margaret is married and has three children who are in high school. She used to be involved in her local church and loved to play racketball. Her husband’s job is very demanding and most of the care of the home and the kids falls to Margaret 

One Year Ago: She has been struggling with her health for several years. She has a Whole Person Risk Score of 104 based upon having multiple conditions, taking several medications, seeing multiple doctors, not being up to date in her preventive care, and not following effective pathways of care for back pain, obesity, fatty liver disease, and depression.

In the last year, she used her full complement of sick leave and had to take a few more days off at her own expense.

She does have a relationship with a nurse practitioner who she’s seen 4 times in the last year. While she’s had no hospitalizations, she has been seen in the local Emergency Room 5 times in the last year.

Intervention

Based on the Whole Person Risk Score^TM the Personal Health Assistant, Sarah, assigned to Margaret reached out to her repetitively for a conversation. Finally, she reluctantly took the call and was pleasantly surprised. The call began the process of building trust and was a positive, supportive conversation where the PHA and she explored how the PHA could assist Margaret in being more successful with her health and well-being. Here is what the PHA learned:

• Margaret felt insecure about using her insurance, the bills from previous doctor and ER visits were high and she was not able to cover them completely, making her try to avoid using any of her benefits
• She knew that there were programs for weight loss, stress and depression, and joint pain but she was unsure which to use first or if she was a good candidate
• She liked the Nurse Practitioner but was unsure how much she could trust her or if the NP understood and could prescribe what a doctor could
• She felt she needed a specialist for each of her problems to get the best care
• She was the heaviest she had ever been and felt discouraged and no longer motivated to “fail again” trying to lose weight
• She was very anxious about how long she could keep working if her conditions continued to get worse and did not know what she would do with her family’s support.

 Margaret & Sarah’s 1^st Year Journey

During the initial 30-minute conversation Sarah listened and asked questions to better understand that Margaret was feeling confused, scared, and immobilized by concerns about how to use her benefits. While she knew that the ER and not working with the NP consistently was not the best way to deal with her problems, she did not know what to do. At the end of the call, Sarah and Margaret set up a second call to review her Personal Health Summary which reviewed all her diagnoses, medications, doctors, procedures, and recommendations to get healthier. After reviewing this Margaret realized that she needed to address these issues and take a different approach. With Margaret’s permission, Sarah shared this comprehensive summary looking at past utilization, and the key steps for the future with her PCP’s office.

Sarah and Margaret made a list of the challenges, prioritized them, and set up the next meeting. Over the last year, Sarah patiently walked through the opportunities Margaret’s company offered. Margaret could barely believe all that was being offered and was so appreciative of what she had access to. She signed up for them as the problem they addressed became the priority and between the programs and her primary care doctor (supported by the NP) she gradually overcame them one by one.

Margaret started with 2 key goals: to build a connection with her PCP and address her mood challenges. Sarah helped her engage with the employee assistance plan (EAP) to discuss the emotions she was experiencing and get supportive coaching about how to address them and how to communicate what was happening to her doctor. At the same time Sarah scheduled an appointment with the PCP collaborating with the NP she was seeing for an annual exam.

These went well and her PCP took her off some of her medications (which had been causing side effects and financial stress) and put her on a mood-improving medication that she learned was both safe and inexpensive. During her initial visit, her PCP did a breast and cervical cancer screening exam and ordered her mammogram and colonoscopy which Sarah helped her get set up and done. At first, she felt a bit guilty that she wasn’t seeing her OB/GYN who delivered her children, but realized that this was time, energy, and cost that her PCP could save her. Her EAP coach helped her identify the key symptoms that bothered her the most and the PCP, EAP coach, and she kept working together until they were 80% resolved.

This led to her wanting to be more active. She joined the MSK program offered by her company where again she got a coach. Basic exercise bands and tools were sent to her home, and she began – slowly initially – to be more active and to address her back and knee discomfort.

She knew her weight was contributing to her fatigue, sleep, and MSK issues, and after a lot of encouragement from Sarah, she signed up for the weight loss program through an APP offered by her employer and she liked it.

Margaret & Sarah’s 1^st Anniversary of Working Together

As shown in the table, Margaret is in a very different place. With Sarah, she has a trusted companion and coach on her journey who, while not a doctor or nurse, has increased her understanding and ability to use her benefits, the healthcare system, and her medical and medication issues.

Her company that funds Sarah saved at least $10,000 on her healthcare as she has become more proactive and much less afraid and reactive. She is optimistic she will be able to work until retirement in 10-15 years.