Getting a Better Picture of Members for Better Health Outcomes
The Challenge: Poor Quality Data Is a Barrier to Engagement
There is much more to each member than their claims data and history. Tailoring your message and healthcare offerings is about seeing each member as more than a diagnosis or billing code.
As a payer, you receive information about a member each time their healthcare provider submits a claim. But that is often a limited snapshot into the individual, especially when data is incomplete, missing or inaccurate. Some populations may be especially vulnerable to incomplete records. Members with lower access to care, for example, might become a casualty of the inequalities perpetuated by incomplete healthcare data. Not knowing the whole picture for a member prevents payers from offering support that is relevant and timely.
In addition to poor quality data, social factors can play a role in health outcomes. Members have unique needs based on their geographic location, financial situation, individual healthcare challenges and more. The goal is better health outcomes and you can impact that by sending relevant, targeted messages that may be impactful to a specific population. Factors like knowing a member doesn’t have support at home may help you determine who might need more engagement. Social determinants of health affect up to 50% of health outcomes.1
New Rules for Star Ratings
To support better health outcomes, the Centers for Medicare and Medicaid Services (CMS) has launched the Excellent Healthcare for All bonus program. This program has changed HEDIS score calculations and focused on three specific groups: persons with disabilities, dual eligible and persons who qualify for low-income subsidies. This program makes it necessary to know enough about your members to send tailored communications to achieve high quality care. The EHO4All bonus program will cause a big impact on payers Star ratings. In a CMS simulation of 2021 data, 13% of plans are expected to lose ½ a star which can mean millions of dollars to plans.2 Meeting HEDIS standards is top of mind and payers are focused on the five key factors to meet the EHO4All bonus standards.
The challenge is driving better health outcomes for your members, helping them live healthier lives. And healthier members impact quality measures, cost savings and revenue. Another challenge is having the right and updated data and to support that goal. Engagement is a big part of the equation of health outcomes and yet, members who need help the most aren’t connected. The average engagement rate for at-risk members is below 30%.2
The Solution: The Right, High-Quality Data
Payers need to optimize operations to meet the Star ratings. Engagement is critical to such factors as patient experience. If you have outdated contact information, members may not receive reminders for health screenings. When they take the survey, they may rate a plan poorly for the staying healthy category. Work with a data company and use up-to-date member contact information.
Having more information about your members will help anticipate needs that impact health outcomes. For example, if you know someone doesn’t have transportation to go to a follow-up appointment after a hospital stay, you can arrange for transportation. Another example is if you know someone lives alone, they don’t have help to adhere to medication regimens. In this case, you can check in with the member to see if more is needed to help with medication adherence. It’s important to know your members better to encourage better health. Work with a data partner to get the social factor information for your members and help you keep contact information updated for better communication.
Key Takeaways: Help Members Live Their Healthiest Life and Reduce Avoidable Costs
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Boost member engagement with data-driven, personalized care journeys
With accurate and enriched data—including claims, contact details and social determinants of health (SDOH)—plans can tailor communications and interventions to each member’s unique needs. This leads to more relevant messaging, higher engagement and better health outcomes.
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Prevent costly complications by identifying and addressing care gaps early
By identifying risk factors early—such as obesity, transportation barriers or food insecurity—plans can intervene before conditions worsen. This proactive approach helps reduce avoidable costs and improves long-term health outcomes.
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Strengthen member trust with seamless, whole person care powered by shared data
When providers and payers share accurate, up-to-date data, members experience smoother care coordination. This builds trust and loyalty, especially when members feel seen, supported and understood across every touchpoint.
Download our Ebook to Learn More
Infographic: Help Your Members Live Healthier Lives With the Right Data
Listen to This Podcast to Learn How Community Care Plan Improved Member Engagement With Data
Listen to this podcast to learn how one of our customers removed barriers with data to improve member engagement. Ken Walters, Senior Vice President and Chief Operating Officer at Community Care Plan shares how health literacy proved critical to engage members in their own healthcare.
See How You Can Use Data to Get a Whole Person Perspective
Health plans are challenged with out-of-date contact information, the first barrier to care. To achieve better health outcomes, a full picture of your member is needed to engage with relevant messages. Our whole person data and insights can help you connect with your members.
Complete Form to Download Ebook
This ebook illustrates how data touches members by taking you through a member health journey. It shows how using data helps deliver relevant messages to members, enabling better engagement and health outcomes. Read this ebook to see how you can optimize engagement with a whole-person perspective.
References:
- Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts, Assistant Secretary for Planning and Evaluation, https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf
- What Medicare plans should know about CMS’ recent health equity-focused initiatives, Milliman.com, https://www.milliman.com/en/insight/recent-health-equity-focused-initiatives-from-cms-medicare-plans