Empowering Employees with Meaningful Connections

Tufts Health Plan: For a healthier, happier workforce

At Tufts Health Plan, we believe that the key to keeping our clients' employees happy and healthy is to build meaningful connections with them at every point in their health care journey. From our customer service to wellness programs to personalized care management, we empower employees to take control of their own health care. The goal: a workforce that’s healthier, happier, and more productive.

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Health plan members who feel their health plan is a trusted partner in their health and wellness are significantly more likely to say they’re satisfied with their plan.1

We’re proud to say that it’s working. The Tufts Health Plan HMO and PPO plans are rated 4.5 out of 5 by the National Committee for Quality Assurance (NCQA).2

The rating is based on our ability to help members:

  • Maintain good health.
  • Live optimally when they have a critical illness or difficult health challenge.
  • Take advantage of screenings, immunizations, and other preventive services.
  • Receive the treatments and support they need to manage their chronic conditions.

As employers know well, when employees are satisfied with their health plan, it means fewer HR headaches and a happier workforce. At its core, our member experience is about ease of access, quality care, and an integrated approach to care.

Here’s how we’ve done it:

1. Making it easy for employees to get engaged, get answers, and get rewarded

Empowering members starts with access: to answers, to support, and to resources that make it easy for members to take charge of their health and wellness. At Tufts Health Plan, we engage and empower members at every step of their health care journey—so employers are freed from spending hours helping employees navigate their benefits.

In a recent survey, 99% of Tufts Health Plan members said they had a positive customer service experience.

  • A seamless transition: We’re meticulous about continuity of coverage when employees switch to Tufts Health Plan from another health plan. This is especially important for patients with chronic health conditions or treatments already in progress.
  • ​Engagement from the start: From the moment employers choose us, we work with them to educate their employees about the tools, resources, and benefits available to them through their plan.
  • Truly helpful customer service: Taking care of our members means more than just coverage. Our customer representatives know our plans inside and out, for a 91% first call resolution rate. They’re fast, too, with an average call answer time of 20 seconds.
  • Personalized assistance 24 hours a day: Members can reach a registered nurse any time, day or night, for answers to their health questions, advice about treatment options, and more.
  • Pharmacy Benefits Manager (PBM) tools: Our PBM partner has invested $300 million in new digital capabilities to make it easier for members to manage their prescriptions, get drug information, and compare prices.
  • Wellness discounts and perks: We give members lots of reasons to stay healthy, with perks including health club rebates, discounts on weight loss and nutrition programs, and savings on natural therapies.

2. Care management that’s compassionate and compelling

One of the most meaningful ways we make an impact on our members’ health is through our care management program. We take a more proactive approach than many plans, identifying and reaching out to members who can benefit from dedicated, one-on-one support. Our care managers help members navigate their care, connect and communicate with providers, and make treatment and lifestyle choices for optimal health. Employees feel cared for and supported, and employers can be confident that we’re actively working to prevent unnecessary costs and complications.

Our care management team engages nearly 93% of the members we reach with our critical programs. -Audrey Sefakis, Director of Care Management, Tufts Health Plan

Our Care Management Programs include:

  • Tufts Health Priority Care: A dedicated nurse care manager can provide longer-term support for employees with complex medical needs, such as cancer or catastrophic injury.
  • Healthy Birthday: For mothers at risk for preterm labor or an underlying complex medical condition, an OB nurse care manager will offer support throughout pregnancy and delivery.
  • Chronic Kidney Condition Management: Our dedicated nurse care managers, in collaboration with physicians, provide education and support to help employees with kidney disease maximize their health and wellness.
  • Transition to Home: With a focus on preventable readmissions, a dedicated nurse care manager provides recovery and stabilization support for selected employees after hospital discharge, including families of children and infants who have been hospitalized or in the NICU.
  • Basic Transitions: This program provides non-clinical Transition Coordinator support for employees who may benefit from assistance with aftercare appointments and service needs after selected hospital stays.

3. An integrated approach to medical and behavioral health

Just as important as employees’ physical health is their mental health. But depression, addiction, and other behavioral health struggles often go unnoticed and untreated, resulting in unnecessary suffering and damaged lives and careers. At Tufts Health Plan, we’re trying to change that.

Nearly 1 in 3 adults with a medical disorder has a mental health condition. 68% of adults with a mental health disorder have at least one general medical condition.3

Behavioral health is an integrated part of our plans; we don’t outsource it like many of our competitors. As a result, we can offer a truly seamless approach to medical and behavioral health—one that takes the whole person into account.

  • A 360-degree view: Our medical and behavioral care teams work side by side—literally—and a shared clinical record between medical and behavioral providers offers a complete picture of every member. This is particularly important when it comes to conditions like cancer and asthma, which come with higher rates of behavioral health issues.
  • Hands-on care management: For employees in need of inpatient behavioral health treatment, our care managers can provide care coordination from admission to discharge, as well as medication oversight and proactive outreach to help ensure compliance.
  • Support for employers: We can help employers recognize the signs of behavioral health disorders and educate employees about the types of behavioral health resources available to them.
  • Meeting the challenge of opioid addiction: The opioid epidemic has gripped families throughout New England. In 2016, Tufts Health Plan launched a dedicated substance use disorder program to help members and their families address the effects of the opioid crisis and the challenges of managing prescription pain medications.
  1. J.D. Power. (2016). Health Plan Member Survey
  2. NCQA’s Private Health Insurance Plan Ratings 2018–2019.
  3. Robert Wood Johnson Foundation. (2011). Mental Disorders and Medical Comorbidity.

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