It is no secret that improving the health of our sickest populations has proven an intractable problem across the healthcare industry with health plans finding themselves increasingly at the center of managing complex care on behalf of their members. The industry has made significant strides in recent years with an increasing focus on maximizing engagement via care management programs. However, health plans are still finding there is no real automated way to impact the health of our sickest populations.
Today, 3-4% of the population still incurs 30-40% of healthcare spending. Managing the care for this cohort requires hands-on, high-touch interactions. The most successful programs have done this in partnership with a variety of providers (non-clinical and clinical) but health plans generally see the most success at the individual member level, one member at a time. In previous years, telephonic outreach and management has dominated the care management landscape, yet health plans are still not able to demonstrate a real improvement of outcomes for these members.
In the industry quest to offer continuous care and engagement, improve access, and keep patients well health plans must embrace technology platforms that enable these objectives. By leveraging a platform approach, health plans can gain a meaningful integration of data, gaining a more holistic view of their members and providing improved experiences, and most importantly, outcomes.
Legacy Technology Continues to Hinder Progress
One of the pitfalls of current care management systems lies at the intersection between health plans and providers. The lines between an EMR, customer service tool, medical management systems, member portals, and claims system are blurred. In addition, huge disparities between systems cause process variation: transferred calls, misinformation and general caller dissatisfaction. Although EMRs are powerful in data content, maneuvering between systems to locate meaningful information can be difficult. A holistic “view” of the member remains elusive for health plans. Communication isn’t defined between users of each system. Email becomes the standard way to talk to other areas of the health plan which increases administrative overhead and impacts accurate documentation.
Inconsistencies in member communication also cloud the picture. Health plans are still battling redundant legacy communications systems with different letters generated from different systems with no transparency into the actual content of its touchpoints with members. In addition to redundancies, errors, and increased overhead, creating an engaging member experience still remains an unmet goal of most care management programs.
Finally, current care management systems are increasingly finding themselves at odds against broader industry dynamics including the shift to value-based care, community-based care, and the need to incorporate broader sets of social data to more accurately time needed interventions.
Promise of Platforms
To combat these issues, health plans need to shift their focus to platform technology solutions for care management. By leveraging such platforms, common user interfaces and shared data can better enable the following key functionality:
- 360 View of the Member: Eliminate administrative redundancies and create an accurate, accessible picture of the member’s health, accessible across the health plan enterprise. Promote higher customer satisfaction via one call resolution and a more consistent, less confusing member experience.
- Meaningful Integration of Data: Platforms bring the availability of real-time data into reality ultimately helping create a single source of truth for the member and ushering in greater collaboration across care functions.
- Ease of Reporting and Ability to Customize: Customizable real-time operational dashboards create greater ease of use.
- Alternative and Secure Communication: Ensure your members and partner providers can interact with you in a way that works for them. Create more engaging experiences and even more importantly, deliver the care they need, when they need it.
To offer continuous care and engagement, improve access to services, and keep patients well, health plans should consider platform-based care management solutions as the technology best positioned to more nimbly enable much needed capabilities: broader data sharing, holistic views of members, and common user interfaces.