Here are five ways payers could help their members become more engaged in their health and provider-recommended treatment plan.
Consumer engagement is a crucial quality- and cost-related issue whether providers effectively engage their patients or payers with their members. However, the responsibility to achieve and improve patient/member engagement often falls to providers, who face limited time and financial resources for the required communication and education that helps engage their high-risk and high-cost patients.
For example, 86% of urban and rural community health centers and clinics, which often serve high-risk patients, report patient engagement has been challenging, particularly in areas related to adopting healthy behaviors and adhering to providers’ treatment plans and recommended screenings, according to findings from The Commonwealth Fund. Nine out of 10 of these organizations reported they would like to more effectively engage their patients, particularly in chronic disease management.
Health plans can a play major role in supporting providers in improving engagement by using claims data, analytics tools and outreach services to communicate and educate members, help them overcome treatment plan adherence obstacles, but also connect them with community resources that provide free or deeply discounted medical and wellness services. When members are better engaged in their care, not only do provider organizations benefit, but health plans can also improve their HEDIS and Star ratings, risk scores and financial performance. The following are five ways payers could help their members become more engaged in their health and provider-recommended treatment plan.
1. Data analytics. Engaging all members is the ultimate goal, but concentrating on the highest-risk, highest-cost members needs to be the top priority. For example, although they account for only 18% of Medicare beneficiaries, “dual eligibles,” Americans who are eligible for Medicare and Medicaid, were responsible for 33 percent of the spending in 2011, according to the Medicare Payment Advisory Commission. Per-capita spending on the dual-eligible population that year was $19,113 per member compared to $8,685 per non-dual-eligible beneficiary.
By leveraging claims, abstracted EHR information, pharmacy, lab and other data sources, plans can proactively identify and address gaps in care and improve risk scores among dual eligible and other high-risk populations through education and facilitating physician visits. Although lacking in the more granular data located in the patient chart, health plans have insight through claims into where members have been seeking care throughout the continuum, such as emergency departments. This care continuum-wide perspective is crucial to stratifying risk and establishing engagement.
2. Multichannel outreach. Once members are identified, plans can begin contacting members through multiple channels, such as text messaging, email, automated telephony or a smartphone app. Automated, but interactive telephone outreach can support members in managing their chronic condition such as diabetes, CHF, COPD, but also for maternal-health education between check-ups, hospital discharge follow ups and to intervene with emergency-room frequent users. This broader and consistent engagement of member populations can be delivered cost-effectively, freeing up time for live care managers to assist members with more complex needs. The automated service, however, can also be highly personalized and natural, allowing the member to speak their responses as if they were talking to a live person.
3. Health advocates. Providers may not have the time or resources to educate all their patients about their chronic conditions or upcoming tests and procedures. Non-clinical health advocates representing the health plan can offer educational resources and fill in informational gaps so the member/patient is confident about their care and self-management. Advocates can also schedule primary care physician appointments and remind members about upcoming scheduled visits for multiple providers.
For members unable to visit their provider, payers can encourage engagement by offering a home visit from a healthcare professional representing the health plan who would document conditions, perform lab tests, and present follow-up recommendations. The clinician’s documentation would then be shared with the member’s primary care physician on record for any follow-up.
4. Community and social program support. A major engagement obstacle, especially among high-risk patients, is the out-of-pocket costs associated with their care. To serve this population, there are more than 10,000 publicly and privately sponsored social programs in 50 states that help members pay for care or receive free health and wellness services that health plans could align with their members. Through an automated telephone program or live health advocate, the health plan can also help the member determine if they are eligible for Medicaid and assist with the application process.
5. Continued educational tools. Once the relationship and engagement between the payer and members is established, it is crucial the plan continues to provide consistent communication, education and treatment plan support even if members are fully adherent with all aspects of their chronic care management.
Engagement support is a significant benefit that health plans can offer provider organizations. With payer organizations’ access to data analytic tools to identify high-risk patients and health advocates to perform outreach, health plans can encourage their members to seek the care they need and overcome obstacles preventing them from effectively managing their multiple chronic conditions, thus improving quality and reducing costs for all stakeholders.
Jim Dalen is chief health economist for Altegra Health.