New technologies and increased accessibility are expanding the range of solutions, innovations and analytics capabilities that lead to consumer insights and opportunities for payers.
Care management isn’t a new concept for payers—and it’s well-established that care managers can help improve health outcomes, strengthen member engagement and lower costs for payers. Now, technology makes digital care management possible, and the benefits are even greater.
The Robert Wood Johnson Foundation defines care management as:
“A set of activities intended to improve patient care and reduce the need for medical services by enhancing coordination of care, eliminating duplication, and helping patients and caregivers more effectively manage health conditions.”
Digital care management involves using digital technology for those same activities. Examples might include providing patient education through an app, or using multiple channels, such as texting and email, to communicate at crucial moments. Further, modern tools such as machine learning, automation and predictive analysis allow payers to better understand patient populations and their needs.
5 Benefits of Digital Care Management
Digital care management provides an opportunity for payers to improve the return on their investment in care management programs, while delivering a better experience for members. The COVID-19 pandemic helped patients become far more familiar with digital tools for managing their health, and it also revealed areas where payers can take better advantage of technology.
New vendors are delivering solutions, innovations and analytics capabilities that lead to consumer insights and opportunities for payers. Benefits of digital care management include:
1. Cost savings for the payer
By making sure that members receive the appropriate level of care when they need it, payers can save money. Right-sizing care management means focusing on the clinically appropriate care at the right time. For example, if a payer puts all members with diabetes into the same category and offers them all the same type of care management, members whose disease is well-controlled receive the same intensity of care as those with multiple comorbidities. Digital care management allows payers to more appropriately tailor the care experience to members’ needs.
2. More convenience for members
People are better equipped for digital care management than ever before. More than 95% of Americans now own a cell phone of some kind, making access better than it ever has been. Along with access comes the ability for care providers to easily send messages. Apps can send notifications and automatic reminders for appointments or other instructions, and all of these activities can take place in a way that is convenient for the member.
3. Better detection of chronic conditions
Digital care management creates additional opportunities to promote preventive care. Even healthy members benefit from the education and convenience available through digital care management.
Along with member engagement, digital care management programs can use predictive analytics so that payers have a better idea of which members have an increased risk of developing a chronic condition, being readmitted to the hospital, or other adverse events. Predictive analytics allow payers to focus preventive efforts where they are most likely to yield better outcomes.
4. Controlled timing
Sending all members of a patient population the same content isn’t particularly effective. With digital care management, the most appropriate content can be sent at the best time. For example, information on recovering from joint replacement surgery is more useful to arthritis patients who have scheduled such a surgery than it is for patients who have recently been diagnosed with arthritis. Timing matters, and digital care management gives payers the tools to get the timing of content delivery right.
5. Communication according to member preferences
Getting the right content to the right member at the right time makes no difference at all if that member never sees it. Traditionally, payers and healthcare providers have communicated with members in ways that were more convenient to the organization, without much regard to what the member prefers. With digital care management, members can choose how they prefer to receive communications. Engagement is better when communication happens in a way the member prefers.
Challenges of Digital Care Management
Clearly, challenges exist for payers. “As the disparity between patient portal availability and adoption has taught us, usability is the key to driving active patient engagement in digital tools,” Bronwyn Spira notes in MedCity News. The existence of the tools isn’t enough to drive their use. Design can be a hurdle for payers.
Another challenge is choosing the best tools and vendors. One of the key steps in implementing a digital care management program is making the best use of technology and automation. The right digital tools reduce the number of hours staff must spend performing tasks manually and, when implemented strategically, streamline the entire process.
Approaching digital care management from a consumer perspective may require a cultural shift for payers. “Healthcare has been relatively slow to pick up on consumer engagement trends, such as micro-targeting, personalization, and sticky engagement tactics, that are used in the technology and consumer sectors,” according to a report titled “The Untapped Potential of Payer Care Management” from McKinsey & Company.
Efforts to engage members are far too often limited by the data on file with the payer. Outdated contact information and claims data can be problematic when it comes to digital care management. With incorrect contact information, any efforts at digital care management won’t work, and claims data provide information after the fact, rather than at an appropriate time to initiate contact.
The Time Is Now
Even with all of the challenges inherent in implementing a digital care management program, the time to get started is now. The population is aging, the pandemic left many more people with long-term health issues, and most people have access to the digital tools necessary for engagement in the digital realm. Furthermore, the tools necessary for payers to increase ROI from digital care management are increasingly innovative and accessible.
“How would healthcare change if we applied technology to optimize the process of healthcare to complement its practice? Could we improve the quality of each interaction through better resolution and tracking of symptoms? Or in the early communication of this information with the physician in real time? This is the role that digital care management companies aspire to serve in the practice of healthcare,” Leo Patrossian writes in Physicians Practice. Moving toward improved patient outcomes, value-based care, increased member satisfaction, and payer cost savings make digital care management worth the effort of implementation.
About The Author: Medecision
Medecision® is a digital care management company whose solutions and services are used by leading health plans and care delivery organizations to support more than 42 million people nationwide. Aerial™, a HITRUST CSF®-certified, SaaS solution from Medecision, seamlessly connects the healthcare ecosystem to powerful data and insights that drive meaningful consumer engagement while creating efficiencies to reduce costs and support effective care, case and utilization management. Aveus, our professional services division, helps business leaders solve complex challenges and drive better performance, leaving organizations more capable.
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