Payer Care Management initiatives of 2020: Trends and observations

Sandeep Gupta
Thu 04 February 2021

Size of care management market, growth drivers and cost savings in 2020

It is estimated that the healthcare management market will be worth around $20 billion by the year 2023. In the year 2020, the market recorded a compounded annual growth of 16.1 percent. Areas of projected growth include: disease management, case management and utilization management

Care management, a payer industry submarket, calls for a variety of new initiatives. As a part of the patient-centered care movement, care managers have to be provided with health data through third party applications, and doing that requires healthcare information technology developments. The Medicaid patient population is also aging, which means there may be increased costs and utilization of resources. As a result, care management assumes a vital place in payer strategies to manage quality, costs and government regulations.

A recent study revealed that vulnerable populations under care management programs incur lower costs and experience better outcomes than those who don’t avail care management.

Three full-risk accountable care organizations managed to earn shared savings of close to $27 million, out of which $15 million is attributable to care management initiatives. Care management program users spent 22 percent less on healthcare resources than those who didn’t use the program every month on average.

The way forward: Things to consider in 2021

Care management initiatives have gained traction and have proven how they can impact health outcomes, member engagement and costs. Payers now need to create even more patient-focused care team workflows and empower care coordinators with more time to focus exclusively on members. Only 11 percent of Medicare Advantage enrollees received communication from their health plans. Low engagement translates into poor care management and can even result in high member turnover rates.

Automating workflows is a way to reduce the administrative burden on care teams and give them the opportunity to dedicate more time to the members. Leveraging technology to take care of the tasks that can be automated, especially ones that pertain to data, and focusing on delivering in-person care is the way forward in care management.

Current challenges in care coordination

Payers are keen to embrace new technology to improve care management and their members’ overall care journey. However, there is still a long way to go. Here are some challenges in the care management process:

Excessive time spent on outreach: The majority of care team members’ time is spent creating reminders or confirming events/appointments, creating lists of patients, and sending individual messages to patients. They are not left with enough time to actually interact with the patients.

Members failing to show up: When patients don’t get to interact with the care team members, they are less engaged and are not inclined to follow through with the complete care journey. Lack of communication leads to low medication adherence and high utilization of emergency visits and hospitalization.

Low efficiency: With administrative tasks taking most of the time and energy of the care team members, they are burnt out by the time they connect with the patients. Administrative activities can be intricate without technological assistance.

Poorly informed patients: Minimal attention from care members leave patients confused about their treatment and medication. They don’t have the information to make the correct healthcare decisions. This can lead to disengagement and high attrition rates.

Leveraging a Healthcare Data Platform for Payers

To improve care workflows, it is important to unburden the care team members from menial but intricate tasks that can be completed with technology. Navigating through huge amounts of patient data is one of the biggest challenges that technology can solve. Healthcare data platforms can aggregate the data and provide analysis that caregivers can use to take proper care of their patients. With streamlined data and valuable insights, care teams can get a comprehensive view of their patients’ health status and journey and drive timely interventions, thereby preventing emergency episodes.

For health plans, positive outcomes are driven by robust member-population health initiatives that bring together successful individual health results. Health plans require a solution that understands their members better and improves care at both individual and population levels. A healthcare data platform does exactly this.

Innovaccer’s healthcare data platform for payers ingests huge amounts of data present in EHRs and analyzes it to reveal insights and highlight gaps in care for every patient. It provides a complete view of the patient and their care journey along with pinpointing the gaps and identifying ways to close them.

To learn more about improving care management Innovaccer’s Healthcare Data Platform for payers, get a demo.

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