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Three Ways Health Plans Can Bring Patient Insights Into Focus

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A staggering 97% of physician practices reported a drop in patient volumes last spring. Citing safety from COVID-19 as the top concern, some skipped routine screenings that will eventually lead to delayed cancer diagnoses, while others missed appointments that will exacerbate chronic or complex conditions. Although there was a general return to pre-pandemic visit levels months later, it has been uneven by specialty. According to research published by the Commonwealth Fund, visits to dermatology, adult primary care, ophthalmology and urology were growing by early October 2020, yet, specialties such as pulmonology, otolaryngology and cardiology still lagged behind.

In the months and years ahead, we'll likely be dealing with the health and financial ramifications of patients whose health issues went untreated or undertreated during the pandemic. That's why health plans are doubling down on care management, a range of activities that healthcare professionals use to effectively manage patient health conditions, improve patient care and reduce the need for medical services. Fortunately, there are new and innovative approaches to care management that leverage health IT tools. Here are a few examples of how technology can help health plans build stronger care management programs for better health outcomes.  

Connecting Care Providers

Many care management directors occupy a uniquely challenging role, supporting a team that operates with scattered information about the members they are assigned to help. Often, member information is siloed in different systems and getting this information is difficult, leading to delays, redundancies and confusion.

Care management directors need timely and accurate clinical data and information. Clinical Direct Messaging lets healthcare professionals seamlessly send and receive information securely across multiple care collaboration scenarios within their existing workflows. Tools like these give care teams a clearer picture of their members and populations, allowing them to spend less time tracking down information and remain focused on ensuring appropriate, timely and cost-effective care.

Increasing Medication Adherence

Poor medication adherence is regularly the result of patients being unable to afford their prescriptions or because of friction like manual prior authorization in the prescription process. According to a Surescripts survey, over half of patients have poor medication adherence because their prescriptions are too expensive. But with the technology available today, like Real-Time Prescription Benefit, prescribers and pharmacists have access to patient-specific cost of medications based on their plan, deductible and out-of-pocket spending for the year. And with solutions like Electronic Prior Authorization, providers can recoup time and deliver medications and better experiences on time.

New federal regulations are recognizing the importance of helping patients get the necessary medications at an affordable cost. A new Centers for Medicare &Medicaid Services (CMS) rule requires Medicare Part D health plans to adopt real time benefit tools capable of integrating with at least one prescriber's electronic health record software. This allows care providers to work together with their patients to identify and remove cost barriers so that patients can get the medicine they need.

Another useful tool is Insights for Medication Adherence, which delivers member-specific data directly from PBMs to clinicians, identifying gaps in care and high-risk medications. When providers have these insights, member outcomes and CMS star ratings are both likely to improve.

Identifying Opportunities to Educate

Finally, digital technology can help provide insight into missed or delayed essential treatments, shining a light on the need for better information sharing around high-risk populations.

Medication History for Populations helps providers quickly identify members within value-based care populations who may benefit from outreach concerning their medications. Insight into medication activity gives care managers a powerful tool to reduce readmissions and improve treatment and outcomes.

How Aledade Improved Its Star Ratings 

How Aledade Improved Its Star Ratings

How did an ACO representing 840,000 patients avoid nearly 600 patient interventions? (Hint: Medication History for Populations.)

Learn more about how Surescripts is increasing patient safety, lowering costs and ensuring quality care. Check out more articles our blog, Intelligence in Action.