Despite the uncertainty in today’s healthcare marketplace, certain fundamentals remain true. Today’s health plans must identify members who either have or are at risk for high-cost diseases; they must engage those members to close gaps in critical health measurements; and on the basis of these measurements, they must connect members to interventions that can improve the overall quality and efficiency of care. Nowhere is this more evident than in populations with a high burden of chronic disease.
More than 141 million Americans have one or more chronic conditions , according to a 2015 RAND Health study. Additionally, two-thirds of Medicare beneficiaries have two or more chronic conditions such as diabetes or heart disease, according to CMS. Yet a January 2017 HealthMine Health Plan Intelligence Survey of 750 insured consumers who are enrolled in a wellness program found that half of health plan members with chronic conditions are contacted by their insurer once per year or less. Only a quarter of respondents in the survey received any intervention from their health plan relevant to their illness.
It’s no surprise then that gaps in the screening, monitoring, and management of chronic diseases abound, even in managed care settings.
Why are so many health plans struggling to build programs that close these gaps and improve chronic disease management at scale? There are a litany of reasons (fragmented delivery systems, hard to engage membership, evolving relationships with providers, budget constraints, etc.) but the effective use of technology to deliver interventions in a manner that’s both scalable and consumer friendly can help to overcome them.
A pathway to improved gap closure
Here are five ways technology can make health measurement and gap closure programs more effective:
1. Improve communication. Building multichannel communication capabilities is a good first step toward reaching more members. Selecting channels based on member preference, improving the accuracy of contact data, and capitalizing on member-initiated communication can make multi-channel communication come to life. Technology can help organizations learn what channels are most effective, shift to channels that have a greater impact in a given population, and provide those lessons to other stakeholders at the health plan.
2. Incorporate behavioral science. It’s important for health plans to understand not only who’s eligible for a gap closure intervention, but how to move individual members to participate. Technology can operationalize advances in behavioral psychology at scale, offering choice where it was previously unavailable, delivering messages tailored with more intelligence and human touch, and escalating engagement when members are unresponsive.
3. Leverage provider networks. Technology can enable plans and providers to present a unified message to members by delivering cobranded outreach and services, linking programs back to providers and driving participation. It can also help plans to improve engagement among member populations who haven’t designated a PCP, reaching members at home or in alternative settings such as a retail space. Finally, technology can facilitate physician engagement and be tailored to a network or practice in a manner that pairs with existing workflows and staffing.
4. Ease program administration. Technology solutions can provide timely, easy-to-interpret reports that measure the success of gap closure campaigns and facilitate program management. Reporting should highlight areas where a program is failing to reach members and provide actionable data to address those challenges. Technology can also simplify the configuration of new programs, facilitate the delegation of program management duties to stakeholders across an organization, and automate repetitive program tasks.
5. Generate insight. Technology can enable organizations to measure not just the number of gaps closed, but the downstream effects of gap closure programs on outcomes and utilization. The right technology can facilitate insight into return on investment, member engagement, and population health impact by cohort, a line of business, chronic condition or other parameters.
Joshua D. Sclar, MD, MPH, is the chief medical officer for BioIQ, a software company that offers a population health measurement platform. Sclar is board certified in preventive medicine and public health and has over 15 years of healthcare experience.