Enhancing Core Care Management Functions: The Key to Member Satisfaction

Healthcare payers can enrich their members’ care experience through proficient care management. The most important aspect of care management is engaging members, however, not many health plans have succeeded in their initiatives. There is a need to accumulate, organize and analyze the huge amount of member health data and derive critical insights through digital tools. It is estimated that technology-driven care management initiatives can lead to savings between $175 billion to $220 billion annually in the U.S.

This whitepaper will shed light on the importance of care management for healthcare payers. It will also explain the efforts made to improve care management so far, the challenges encountered and solutions. Centers for Medicare and Medicaid Services recently increased the weightage of patient experience, access and satisfaction from 2 to 4 in the assessment of Star Ratings. This implies that MA plans have to work on their patient engagement strategy as a part of their care management initiatives.

Key Highlights:

• What is care management, and what it entails for payers
• Initial steps taken to align payer care management in the care continuum
• Challenges faced by health plans in care and disease management
• Focusing on the key component of care management: Member engagement
• Challenges in communicating with members
• Leveraging a Healthcare Data Platform for payers to connect and guide members and improve the process of care delivery