Health Plans | Member Engagement Consumer Engagement

eviCore’s Consumer Engagement programs offer a variety of solutions that educate patients through personalized interactions. From SmartChoice site redirection and alternative therapy programs, to HEDIS and Star programs, our Consumer Engagement programs deliver innovative, informed options and cost transparency.

Members

Our consumer engagement concierge team communicates with the health plan member to inform them of their options for procedures based on cost, quality, and convenience. Other options include benefit differentials as well as customized appointment reminders.

Health Plans

eviCore’s Healthcare Economics Team analyzes elements such as the costs and geography inherent in certain procedures to increase network penetration and identify better opportunities.

Physicians

Our Consumer Engagement Team makes sure that referring physicians are informed of any member activity jeopardizing scheduled procedures, facilities, and appointments. Consumer Engagement also assists with appointment adherence when implementing the member reminders.

FAQs

What is SmartChoice?

SmartChoice is a program that partners with health plans and their members to empower members to become active consumers in how they spend their healthcare dollars and where they have their services performed.

Can I choose a cost-effective facility for my patient?

During the process of creating a pre-certification request, eviCore will offer a list of cost-effective facilities, and you can choose one for your patient. 

What about the facility I select?

Your preference will be recorded, and the eviCore representative will include this facility on the list when we call your patient. As part of the SmartChoice program, health plans are letting their individual customers know their options for imaging as well as the costs involved.

How will I know where my patient is going?

Once your patient has selected a facility, a fax specifying the authorization number and their chosen location will be sent to your office as well as to the selected facility.

I got a message from a SmartChoice representative asking me to call back; why are you calling me?

eviCore’s representatives are calling to offer choices about where you can receive your medical scan. Many of our partner health plans offer their members additional information about cost-effective and convenient locations. All these locations are accredited to ensure they meet high standards for quality and safety. We called to let you know there are a few near you that can provide the same service to you at a lower cost.

Why didn't you call me the last time I had a procedure?

We only contact our members when there are lower-cost facilities available in their area for participating health plans.

How will my doctor know where I am going?

Once you have selected a facility we will send a fax, including your authorization number, to your doctor’s office and the facility you have selected.

Don’t I have to go to a hospital for my procedure?

No, you can undergo your procedure at a location convenient to you.

How did you get my phone number/information?

As part of your coverage, MRIs, CTs, and PET scans must be reviewed by our radiology specialists prior to the service being provided. Your doctor's office contacted us about your scan and gave us your phone number.

What can physical therapy do for my lower back pain?

Researchers found that people who were initially prescribed advanced imaging, such as MRIs, for management of low back pain ultimately paid more and were more likely to have surgery or injections, or to visit an emergency room, compared to those who were sent first to physical therapists.  Based on a thorough examination, physical therapists can use any of the following treatment options:

  • Manual therapy, including spinal manipulation, to improve the mobility of joints and soft tissues
  • Specific strengthening and flexibility exercises
  • Education to teach patients how to take better care of their back
  • Training for proper lifting, bending, and sitting; for doing chores both at work and in the home; and for proper sleeping positions
  • Assistance in creating a safe and effective physical activity program to improve overall health
  • Ice/heat treatments or electrical stimulation to help relieve pain.
What can chiropractic services do for my lower back pain?

Chiropractors practice a hands-on, drug-free approach to healthcare that includes patient examination, diagnosis, and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary, and lifestyle counseling.

One of the most common and well known therapeutic procedures performed by chiropractors is spinal manipulation (sometimes referred to as a "chiropractic adjustment"). The purpose of spinal manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile―or restricted in their movement―as a result of a tissue injury.

What is chronic pain?

Chronic pain is any level of pain that lasts for more than 3 months–or beyond an expected normal healing time. Those with chronic pain feel that their body has not healed, when this may not be the case. Chronic pain has lingered beyond the initial warning of danger to the body. Anyone can develop chronic pain, at any age. Furthermore, the brain changes when a person lives with chronic pain:

  • When pain is constant or chronic, the brain and nervous system become highly sensitive, making it easier to experience pain. This becomes the “new normal” for the body and keeps the person in a heightened state of sensitivity even though the injury may have healed.
  • Pain can affect many different areas of the brain―areas that may control an individual’s flight or fight responses, movements, emotions, problem-solving skills, and memory. We develop new “pain memories” that are unconsciously associated with an activity or emotional, or social situation.
  • Almost any system of the body can be affected by chronic pain. As an individual continues to experience pain, the circulatory and endocrine systems adapt to pain responses and can negatively affect whole health.
  • Chronic pain is quite common but should not be considered normal. There are resources available to help individuals find solutions to reduce and potentially eliminate chronic pain.
What are some facts about back pain?
  • Nearly one-third of all adults have low back pain, and 14.2% of them reported an average of 7.6 lost work days per year.
  • Almost 80% of adults experience at least one episode of low back pain during their lifetime.
  • Lying down longer than 2 days does not help.
  • Many people recover just as quickly without any bed rest.
  • The sooner you start physical therapy or chiropractic services, or return to activities such as walking, the faster you are likely to recover.
  • Direct medical costs for spine conditions has increased more than 60% since 1998.
  • Low back pain risk factors include: age (>30 years old), obesity, cigarette smoking, no regular exercise, and heredity.
  • There is little correlation between general arthritis and low back pain.