It’s Blizzard Season for Health Plans

Blizzard season is when health plans need clarity the most. But they’re buried in blind spots.

Come January, health plans brace for what’s known as “blizzard season.”

It’s a surge of new members, benefits reverification and prior authorizations that can bury care teams in blind spots. New-to-plan members often arrive with little to no clinical data, leaving care managers scrambling to identify risks and prioritize outreach, all while balancing returning plan members.

Meanwhile, members may be determining which providers are in their new network, accessing new online accounts, and finding out what their new benefits have to offer.

It’s a flurry of activity with no clear path.

The Challenge: Buried Data

When a blizzard has buried the data, the new-to-plan member never picks up their medication from the pharmacy. That’s because they never got coverage information or made it through the hurdle of prior authorization. And that’s because their medication history didn’t follow them to the new health plan.

Too often, this leads to medication non-adherence.

Delayed engagement, unmanaged chronic conditions, missed opportunities to close care gaps ... these can affect member outcomes and even Star ratings:

• Just not fast enough: The weeks or months-long delay in receiving information based on claims data significantly impacts the ability of health plans to provide timely outreach. This results in reactive care management, rather than what it could be: proactive.
• An incomplete picture: Cash-pay transactions generally aren’t included in claims data. This leads to gaps in understanding a member’s complete medication history.
• Too many sources: Data aggregation is often fragmented. This adds to the time and effort it takes to connect the right patient with the right information.
• Risk assessment isn’t quite right: Without complete data, health plans struggle to stratify risk effectively, leading to inappropriate enrollment in various care programs.
• No warning signs: Enrollment is merely the first step; ongoing monitoring and real-time alerts are essential to identify changes in a member’s status.

For health plans that operate under value-based care models, the blind spot of non-adherence undermines risk adjustment, revenue and member satisfaction.

Medication History for Populations addresses these concerns. 

The Solution: Excavated, Actionable Data

Onboarding new members requires both enrolling them into the right program and ongoing monitoring that includes real-time alerts in the form of prescription notifications.

With Medication History for Populations, care teams can instantly pull all dispensed medications from a single source of truth—no need to wait for claims or member self-reporting—and prescription notifications enable subscribers to get real-time alerts for events like new prescriber, polypharmacy, or missed refills. 

These signals empower care teams to see changes as they happen and to drive a more intelligent, proactive care management approach, where it’s not just about moving data but working to understand and predict it.

That’s how we’re empowering health plans to turn blizzard season into opportunity for improved care management and member outcomes.