3 Critical Tools for Health Plans in Navigating the Great Resignation

Healthcare became the second-largest sector of the U.S. economy to face the effects of the Great Resignation as churn rates surged late last year.

While resignations among frontline workers are highest due to COVID-19 burnout, other professionals are leaving healthcare as well—including at health plans. Now, health plan leaders must consider: “How can we safely and efficiently onboard new members and ensure an unimpeded care journey while dealing with staffing shortages?”

Grossman

For payers, this challenge has the greatest potential to negatively impact operational efficiency and care management. Not only is it more difficult to hire new talent to fill critical vacancies, but in an industry as highly regulated as health insurance, gaps in staffing could hinder health plans’ ability to maintain critical processes. These gaps also limit their ability to identify critical gaps in care for at-risk members, coordinate and facilitate care, and create a seamless member experience.

When “organizational mindshare” is missing, the effects include diminished ability to illuminate and understand new members’ holistic health status, needs, and risk factors—which can hinder premium accuracy—and insufficient data analytics support to prevent worsening outcomes.

Meanwhile, as resignation rates rise to 3% or higher across many sectors, this increases the pool of new members who move from one insurance plan to another, which may play a part in the record 13.6 million Americans enrolling in marketplace coverage during the 2021 open enrollment period. Therefore, it’s critical for payers to take proactive action to protect and maintain member health.

Developing a Great Resignation Toolkit

The pressures on health plans extend beyond filling open vacancies in a highly competitive labor market, where some employees may be able to easily land a higher salary from a competitor or in another industry altogether.

Even when new employees are plugged into vacancies in areas such as customer service or care coordination, these team members may lack the community-specific knowledge to pair members with the right local healthcare resources at the right time. They may also not understand the intricacies of their work until they have spent time on the job.

With so much pressure on health plans not only to get the staffing equation right, but also to avoid disruptions in care, how can leaders create a foundation for member excellence during the Great Resignation? Tools for success include the following:

1. A culturally informed and clinically robust member onboarding process.

Such a process should incorporate understanding of how to tailor member communications and outreach by ethnicity, race, and clinical complexity for maximum engagement. It should also be informed by knowledge of:

• Health needs and preferences by generation
• The social determinants of health that can impact up to 80% of health outcomes
• The supplemental benefits that matter most by member population, such as dental coverage, transportation, or new in-home service offerings for Medicare Advantage members

Data show that income, education, race and ethnicity, employment, community resources, and social support all play a major role in health equity and health outcomes. As a result, the industry is seeing greater sensitivity around the different ways in which members communicate their health status, prior negative experiences with the healthcare system, and what would constitute an ideal healthcare experience.

A culturally sensitive onboarding experience—aided by a specific set of questions that varies by race and ethnicity—supports more meaningful encounters that improve health. When members feel “seen” by their health plan and providers, they feel more comfortable engaging with them. This sets the stage for diversification of healthcare use by population. Such an investment is quickly becoming a competitive differentiator, as healthcare disruptors such as Oak Street Health, Equality Health, ChenMed and Oscar Health are advancing development of culturally relevant models of care.

Developing a generationally aware model for member outreach and care management is also critical. For instance, during the pandemic, some seniors expressed greater desire for in-home physical rehabilitation and monitoring, primary care services, and medication delivery, whether virtually or with assistance from an onsite provider.

2. A proactive, disease-specific approach to chronic care management.

Here, a data-driven analysis that explores the gaps in care most often experienced by members with specific health conditions can help target opportunities to improve healthcare results. For example, at Children’s Community Health Plan (CCHP), an HMO serving primarily low-income families in Wisconsin, an analysis of claims uncovered opportunities for more innovative approaches to behavioral health to meet increased demand for these services during the pandemic.

It also pointed to the growing presence of costly chronic conditions, including opioid dependence and depression-related diagnoses. With this information, CCHP can design interventions by condition that helped prevent members with these conditions from reaching more severe stages of disease, including:

• Assigning a primary care physician (PCP) to members suffering from opioid use disorder: CCHP’s analysis showed 24% of unique members with an opioid diagnosis code did not have a PCP attributed to them.
• Focusing on the ability to influence members with rising risk including depression, many of whom are women, and substance use disorder. A claims analysis revealed five chronic conditions for which depression is most commonly a co-occurring condition: asthma, hypertension, osteoarthritis, congenital anomalies, and hyperlipidimia. The average cost of a member with any of these conditions is 1.3 to 5.5 times greater when a depression diagnosis is present. By ensuring proper treatment for behavioral health conditions among members in these cohorts, CCHP could significantly reduce risk and cost while improving member health and the member experience.

Another approach to consider: developing disease-specific care pathways according to evidence-based practices of care. This helps provide a safety net for members with chronic conditions at an early stage of disease that helps limit disease progression.

3. Tools and technologies that provide a more robust data view.

It’s not enough to just aggregate member health data–health plans must know what to do with that data to make a meaningful impact on member health. With demand for data analysts rapidly accelerating—and with data science experiencing “unrelenting” churn during the pandemic—health plans may need to invest in new technologies or outside expertise. Doing so could bolster their ability to make informed decisions around member health or benefit design.

Health plans should also increase their focus on creating data lakes or repositories to ingest data from multiple sources and in multiple forms. This is especially critical in an era of interoperability, where health plans’ access to data from disparate sources has markedly increased.

With access to a wide swath of data across the continuum of care, health plans can assess the types of conditions that are becoming more predominant among members, particularly at a time when some members are skipping wellness exams or preventive screenings, such as cancer screenings, to avoid COVID-19 exposure. This data view can also help pinpoint which providers have adopted best care practices and provide valuable backup when educating providers who are performing lower-value care.

The Need for a Resignation-Resilient Strategy

The Great Resignation intensified pressure on health plan resources. Now, maintaining quality of care and service will depend on proactive action and innovations in care delivery and support. By developing culturally and condition-specific approaches informed by data, leaders can strengthen service; pinpoint resources needed for new and existing members; and create a longitudinal member landscape to guide success, drive impact, and ensure sustainability of engagement and health outcomes in 2022 and beyond.

RaeAnn Grossman is executive vice president of population health management, risk adjustment, and quality operations for Cotiviti.