Care Management

The rates for closing gaps in care are some of the most widely used, quantitative metrics to measure quality, allocate incentives, and control costs. Unfortunately, health plans face numerous obstacles closing gaps in care, from social determinants of health to inconsistent coordination of care, and don’t always have a care gap closure program in place. Thankfully, digital solutions like web-based scheduling and automated outreach can help health plans jump many of these hurdles while also helping to close gaps in care. Call center schedulingMany health plans are still grappling with the difficulty of three-way scheduling calls between themselves, members and providers. Calls are lengthy and cumbersome as agents dig through binders of provider schedules and scheduling rules to determine and book the right appointment for each member. Members are often put on hold, sometimes more than once, and are much more likely to drop out of the scheduling process entirely when faced with this experience. As a result, these members may face significant care delays, or in some cases miss their necessary follow-up care entirely. With web-based scheduling, member engagement call centers can eliminate three-way calls. Guided search helps to narrow down the right provider for each member and the scheduling platform allows for immediate, on-the-spot appointment selection. Health plans can more efficiently close gaps in care as members can quickly and easily schedule their appointments. This has proven to cut call times in half, and increase scheduling rates by 140%. To learn more, read this case study. Automated OutreachHealth plans typically have a list of individuals to follow up with on a regular (bi-weekly or monthly) basis to book whatever care service is needed to close the gap in care. Now, health plans have the ability to automate this outreach via interactive voice response (IVR) or text message (SMS) while simultaneously enabling members to schedule appointments on-the-spot, either through a link in the text or during the IVR call. The automation improves the member experience with convenient access and helps close more gaps in care – all without a single call center agent. The ultimate combination for closing gaps in careUsed alone, automated outreach and call center scheduling are both effective for closing gaps in care. When used together, health plans can fast track the path to closing gaps in care and further improve efficiencies. Members can first be reached via automated outreach, prompting the individual to schedule an appointment. This allows members the opportunity to self-schedule and essentially self-close their gap in care, without a single live agent phone call. From there, call center agents can pinpoint the members who didn’t schedule as part of the outreach campaign and then call them directly to book the necessary care. We know that despite the flexibility and convenience offered by digital solutions, like automated outreach, there are still individuals who prefer to schedule over the phone and have personal interaction when booking care. The combination of web-based scheduling and automated outreach enables omnichannel access for health plans while helping call center agents focus their attention on the members who need their help most. Contact us to learn more about how Experian Health can help health plans fast track the path to closing gaps in care.

The focus on improving health plan member engagement and overall experience has been steadily growing over the years, much of it being driven by the push towards a more consumer-friendly healthcare experience. James Beem, Managing Director, Global Healthcare Intelligence at J.D. Power, states, “health plans are doing a good job managing the operational aspects of their businesses, but they are having a harder time addressing the expectations members have based on their experiences in other industries where their service needs are more effectively addressed with better technology.” His remarks are based off of findings from the annual Commercial Member Health Plan Study, which also found that care coordination between different providers and care settings is a top challenge health plans are facing today. Most of our conversations with health plan prospects and customers revolve around how digital technology can improve health plan member engagement and close gaps in care. From our experience, here are five key digital strategies that health plans can employ to better engage members and improve satisfaction. Call centers remain a cornerstone of member engagement. From onboarding new members to closing gaps in care, the call center is where the rubber meets the road between health plans and their members. At Experian Health, we focus on making it easier for call center agents to find and book appointments on behalf of members – specifically, we eliminate the need for three-way calls with providers by giving agents access to a digital scheduling platform. It automates providers’ scheduling rules, while also protecting their calendars, and allows health plans to schedule appointments for members without having to call the provider office. In some cases, once our platform is in place, we’ve seen scheduling rates increase by 140%, call times cut in half, and show rates go up. A large factor in social determinants of health is the availability of transportation – are your members physically able to make it to and from their appointment? While members may know what care they need and are able to book an appointment, they may not be able to show up for that appointment due to unreliable or non-existent transportation. The member doesn’t show, the care gap remains, and health plans take a hit on quality metrics. What’s worse, the member puts themselves at risk for readmission or other, costly trips to the ED for care that remains unaddressed – all an expensive medical cost for the plan. We are proud to work with transportation vendors and ultimately, include the ability to schedule transportation in a workflow while booking an appointment. By facilitating easy access to transportation as part of the appointment scheduling process, we are ensuring a better outcome for everyone. Why not offer the functionality that consumers are accustomed to in nearly every other industry? Booking a hotel, flight, or dinner reservation can all be done online via a mobile device, so why not an appointment? Imagine being able to extend this type of convenience and consumer-friendly experience to your members. They come to the health plan’s site or app to search for an in-network provider and can then schedule an appointment in real-time, on the spot, day or night, no phone call required. Instead of simply sending members text and phone call reminders to schedule care, health plans can use automated outreach to send those messages with the ability to schedule an appointment via self-service. The member would receive a text message or phone call, and after confirming their identity, would receive their personal health-related message along with the ability to schedule an appointment as part of the outreach process. In a few clicks, or with a few verbal responses, the appointment is scheduled, and the care gap is closed with very minimal effort. The struggle to find and maintain accurate contact info for members is real. Fortunately, Experian Health has unprecedented access to consumer data. With the largest consumer database, collected on more than 300 million consumers, we can provide a deeper understanding of your current members or prospects in your markets. These data assets can enable the most effective marketing and communication strategies to improve enrollment rates as members are more successfully identified and reached. The data can also be leveraged to enhance internal analytics, like member risk score algorithms or other models, to improve member outcomes. Learn more about how a digital care coordination platform can help your organization improve member engagement and the member experience.

During this time when the whole world is wrestling with the Covid-19 crisis, planning for the future is difficult. However, there is no question that as the nation emerges from its stay-at-home status, there will be huge release of pent-up demand – especially for healthcare. Health systems have streamlined their operations to deal with the influx of COVID-19 testing and treatments. As a result, any non-emergent care or care unrelated to COVID-19 has been heavily gated, if not canceled entirely. This of course includes preventative care, non-critical regular screenings, and other services related to care gaps. Once the patient flow moves out of crisis mode, these services will certainly resume – and they will resume in earnest. This increased demand for services, coupled with the time lost to meet quality metrics, will place a real burden on member services and quality teams as they work to ensure missed preventative care, screenings, and other care related to care gaps are being sought and coordinated. It is possible to make small moves now to strategically prepare for what’s coming, so that when the crisis subsides organizations can be well positioned to serve their members. Here are a few key things payers can do to get ready: Get your data and strategy in order - Now is the time to use data to better understand your members and fill in any gaps you may have. For example, it is going to be essential to understand geographies and associated provider groups where care gap non-compliance is likely to be highest, so you can strategically focus on those areas. Also, understanding what the best channel of communication is and ensuring that you have accurate contact info for those members is critical. Fundamentally, plans will need data that can help them identify who to target and can supply needed, accurate contact info.Understand your members' SDOH barriers – Understanding your members' social determinants of health (SDOH) barriers will be more important than ever. One of the unfortunate byproducts of this COVID-19 crisis is the economic damage. As a result, there will undoubtedly be critical gaps, like transportation, that will affect your members' ability to access care and thus need to be accounted for. Likewise, with the downturn in the economy, additional social determinants will be on the rise, like food insecurity, housing insecurity, and access to medications. These should also factor into your overall plan – and thankfully there are increasing ways to identify and track SDOH.Implement digital tools now – Ensure your member engagement strategy is fully informed and your teams are ready to efficiently execute. While data can round out any information gaps that may exist for you – contact info, SDOH gaps, etc. – tools that can provide quick, convenient access to services will be needed to take action. For example, enabling your member engagement team with a digital scheduling platform that allows them to book appointments with providers without calling the provider, is a proven way to accelerate member engagement and close gaps in care. This type of digital engagement not only provides an efficiency gain, it also greatly improves the member experience as call times are shorter and members are given greater access to care. In times like this current pandemic it can be hard to think about much else beyond the here and now, and especially hard to picture a brighter future. But prudence would dictate that taking a little time now to prepare can make a big difference when things do start to open back up. Find out more about data driven solutions for member engagement.

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The healthcare industry has been talking about the importance of addressing SDOH for years, but many struggle with how to screen and collect the insights.

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