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Population Health for Health Plans & Payers in Value-based Care

As the age-old wisdom goes — prevention is better than a cure. This could be considered a guiding principle for value-based care, which has brought renewed attention to the role of preventive care in managing population health. Health plans and payers have taken note and are dedicating more resources to proactive member engagement as a way to improve outcomes and boost satisfaction.

In our fifth and final blog of the series, we look at member engagement strategies to help payers support better population health and improve the patient experience.

How to Support Members for a Better Patient Experience

Member engagement is something nearly every health plan struggles with, especially health plans that work with diverse member populations that may need more support to address barriers to care. Life circumstances or past experiences with the healthcare system may impact some members’ willingness or ability to seek preventive care. For example, they may not trust or understand their insurance benefits, may have had a difficult experience in the past, or may think it will cost more to seek medical care more frequently.

The role of health plans is to ensure that members know the services available to them and to support navigation of the increasingly complex healthcare system in place today. In addition, health plans should also ensure providers and patient care teams are aware of community-based social support programs and services for housing, transportation, employment, or nutrition that are available through care collaboration platforms.

Taking a member-centric approach facilitates a more proactive engagement strategy by recognizing each member’s unique situation to employ the appropriate messages and outreach methods for optimal engagement and a better experience. Members who are more comfortable using their health plan benefits will be more likely to seek preventive care, which can improve population health and help payers to hit quality score benchmarks.

Leverage Technology Solutions for Member Engagement

The right collaborative partnerships between health plans, members, and providers can help to reduce hospitalizations, decrease the total cost of care, and drive better outcomes — all while enhancing the member experience. Everyone wins when members are happy with their health plan because they are receiving the best possible care in the best possible setting, aided by advanced technology and communications. Technology solutions can offer a more holistic view of member activity throughout the care network by layering other pertinent information, such as health risks, health history, and lab work.

By engaging proactively on the front end, providers and payers are collectively more effective at preventing hospitalizations and other adverse health events. As the healthcare industry continues to rapidly evolve, health plans must place additional emphasis on sharing accurate member information with providers at the point of care to support value-based care goals. A care management strategy supported by real-time, bi-directional patient data exchange provides both health plans and providers with increased visibility into member activity, care, and utilization trends, as well as opportunities to optimize quality programs and value-based care coordination. Health plans can also notify providers of community-based social support services available through the real-time data exchange to make it easier for patients to access these benefits with help from their doctor or care team members.

With CMS shifting the weight of its Medicare Advantage Star ratings to focus more heavily on patient experience, health plans are facing new pressures to engage with their members in an effective way that drives quality improvement and outcomes. With so much at stake, health plans should seek out a proven technology partner that can complement their care management efforts and increase provider collaboration through real-time insights and communication.

Learn more about how PointClickCare can support health plans and payers in the ongoing transition to value-based care

March 21, 2023