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New Technologies Help Payers Battle the Woes of Care Management

Analysis  |  By Marie DeFreitas  
   May 02, 2024

How can payers utilize tools to help with care-management ROI?

Payers have been fighting the woes of care management for a long time. Taking the extra step to educate and equip plan members with health tools that they will actually use can be a big challenge.

According to a study by Mckinsey and Company, most payers dedicate about 10% of their administrative spend on care management but are not seeing a ROI.

There’s a lot of talk around the shift to value-based care, but implementation is a different story.

In order to come out on the profitable side of care-management, payers will need to shift their perspective to whole-person health. This shift will likely be more taxing compared to dwelling in traditional health concepts, (at least in the commencement phase) and it will take innovation, dedication, and consistency for payers to create a sustainably profitable care model that keeps their members engaged.

Why Help Is Needed

Payers haven’t been faring too well when it’s come to member engagement, particularly on their digital platforms. With Medicare Advantage plans usually seeing lower rates of engagement, combined with new, stricter rules for calculating MA star ratings, payers need to start looking to new platforms to improve their MA plans.

Regardless of how payers implement new tools, improved care management and member engagement are two critical factors for health plans to retain satisfied members. Since the COVID-19 pandemic and all the consumer-tailored health solutions, ーsuch as telehealth optionsー that came with it, members are increasingly seeking an easy, well-rounded experience when they interact with their health plans. With better tech, and a little thoughtful innovation, payers can offer this while simultaneously improving the ROI of their care-management solutions.

Payers need functional tools that allow them to engage with the providers in their networks. When payers are able to do this and increase all-around participation in their care-management programs, member engagement improves, as can star ratings, and better, informed health outcomes.

But What’s Out there?

There are endless technology options available for payers with new options frequently popping up.

For example, on April 25 WebMD Ignite announced HealthHub Interactive for health plans.

The new HealthHub Interactive will allow health plan clinical teams to engage with members in a more personalized, effective way. The new platform combines Webmd’s HealthHub and HealthAdvisor platforms and each platform in the bundle speaks to a specific healthcare function.

The newest bundled platform will also allow payers to pinpoint the populations that are less engaged with their health and make targeted outreach to them.

Kyruus Connect for Payers is another option that offers the streamlining of data and optimal transparency, something members rate highly in a health plan. Kyruus Connect allows members to make informed care decisions, search providers, and know their costs, all while staying engaged on a platform that offers a consistent experience from every angle.

HealthInteractive and Kyruus Connect are just a couple tools that payers can utilize to offer a comprehensive solution to care management. As more innovative health tech solutions emerge, payers can choose from a variety of options to get a handle on care management and conquer member engagement.  

Marie DeFreitas is the finance editor for HealthLeaders.


Payers need to improve their care management programs

The rush of new tech options can offer more solutions to payer member experience speedbumps and improve ROI

Members care highly about transparency and ease of use on their health plan platforms

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