How can health plans identify and close gaps in care? It’s not an easy question to answer. Identifying member care gaps requires real-time member data and health history information. Closing gaps in care depends on coordinated outreach and support from care teams. But where can your plan start? Building stronger member relationships can help your health plan access vital care gap information while improving the quality of member outreach and communications. Offering digital engagement channels makes it easier to understand and support your members’ whole health needs—including when they’re facing gaps in care.
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DATA CHALLENGES
IDENTIFY MEMBERS
CLOSE GAPS IN CARE
Closing gaps in care through better member relationships
Identify and reach members
As a health plan, you have access to a wealth of member information. But the insights your team has aren’t always the most robust or up-to-date.
Medical claims contain vital member health information. But claims information comes after a significant lag time and only covers members’ clinical diagnoses. Plus, these insights show what has already happened to a member. Many health plans have become skilled at using this information to help predict members’ future needs. However, these inferences aren’t always accurate to what a member actually experiences. And plans are still missing out on real-time member health data that can better inform preventive care.
To access real-time member information, health plans often rely on telephonic outreach. Phone conversations do offer more real-time health information than claims data—but it’s not the most efficient option. Successful telephonic outreach is dependent on staff’s ability to catch members at the right time, which often results in playing phone tag. For many members, phone calls can be inconvenient, making them less willing (or unable) to stay on the phone and answer questions. This leads to staff prioritizing which members to reach out to, leading to missed opportunities and touchpoints with other members.
DATA CHALLENGES | IDENTIFY MEMBERS | CLOSE GAPS IN CARE
Wellframe doesn’t just add digital interactions—it can improve the performance of all member touchpoints. We found that when care managers used digital channels to establish a trusted relationship, members were more likely to answer phone calls from them.
Identify members
Close gaps in care
We know these care gaps exist—members consistently report that they struggle to keep up with preventive care between doctor’s visits. How can your plan ensure members have the right information and resources to make the best care decisions? If your plan relies on marketing or telephonic outreach to engage with members, you may be missing the mark. Members don’t always know when health plan communications are relevant to them, and could be missing valuable information in print or email messages. Often, this is because there’s a disconnect between what staff want to know about members and what members want to talk about. Staff are focused on what they see as members’ most acute health needs, while members want to discuss what is driving their health needs. Getting more relevant and timely member insights starts by meeting members where they are. Offering a variety of communication channels, including digital, ensures members always have a place to start when accessing care and information. Digital Care Management tools enable care and messaging personalization, on-demand insights, and flexibility in member engagement. Members can find the information they need when they want it, with opportunities to reach out to staff when they need to. This can help your care team build trusting relationships with your members, and improve their health plan experience.
With Digital Care Management, health plans can identify care gaps in near-real time while getting a full picture of what's going on with their members. Care teams can uncover information about the barriers keeping members from taking action—not just whether a care gap exists. These insights empower your health plan to support members with more personalized and relevant recommendations between points of care, or whenever it’s most convenient. Digital member engagement delivers value for your plan and for members. Care teams can use digital engagement tools to assess members and keep a pulse on their needs between points of care. Plus, members can connect to staff and share information when it's relevant and convenient for them. Some Digital Care Management solutions, like Wellframe, offer digital screenings that care staff can send based on existing member information. These screenings can help uncover information such as social determinants of health, biometric evaluations, substance use, disease management, and other time-sensitive member insights. This member health data empowers care teams to intervene early and deliver proactive support—creating a more seamless, timely, and personalized experience.
Learn about health literacy
With digital engagement technology, health plans can invest more in member health education. Prioritizing health literacy helps health plans empower members to make the best care decisions for their needs. Digital tools make it easier for plans to provide members with more targeted education. Empowering members with the "why" behind their health choices encourages them to be more engaged in their health, and helps connect the dots between social determinants of health and their own wellbeing. Digital engagement channels also allow health plans to aggregate health and benefits information in one place. Giving members access to a digital resource library serves a different purpose than mailers and marketing communications: it allows members to be more proactive and engaged in managing their care. Members can access a digital resource library at any time through their mobile device, without worrying if the information is trustworthy or relevant to them.
Proactive support
Health literacy
Members aren’t the only ones who need to think proactively about their health. Care teams can leverage proactive health communications to prevent care gaps before they arise. Digital care management solutions give health plans and care teams the deep and timely member information they need to develop strategies that will have more lasting value than downstream outreach. Multichannel communication is altering how members digest and retain information. Access to digital channels is shifting where members go to seek care and resources. Digital care management tools can improve condition management and make healthcare more accessible for members. This is particularly true for members who are Deaf, Blind, or otherwise have difficulty communicating over the phone. In addition, many members with complex health needs may rely on others to help them. That could be a family caregiver, home health aide, or visiting nurse. Digital engagement channels allow care teams to connect directly with caregivers to provide curated resources and support for both the member and the caregiver.
Learn about proactive support
Empower your care teams
We interviewed more than 1,000 U.S. health plan members to understand where members are struggling, and how health plans can best support their needs.
Read our survey report
Managing a health condition is about more than what medications you take or what your lab values show. Digital communication channels equip care teams with the tools they need to help members see the whole picture of their health, and how their care decisions influence their overall wellness. By embracing digital engagement channels, health plans can be strategic with how they pair member education with tools, features, and resources that enable members to take prompt and effective action on their care gaps—and help prevent them in the future.
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