Did you know 5% of insured members account for more than 60% of employers’ medical spend each year? However, only 1 out of 5 of these members will be high cost year-over-year. So, what are the common cost drivers for organizations? They fall into two categories.
First, there’s the member who is healthy and experiences a one-time, high-cost occurrence such as major surgery or a car accident, after which the member makes a full recovery, and is low-cost the following year. Then, there’s the member who may have multiple conditions (also known as comorbidities), juggling different medications, while making several trips to the emergency room throughout the year.
Providing everyone with convenient access to high-quality care is vital, but it’s even more important to focus on helping those members with comorbidities, who need additional support the most. That’s where Care Management comes in: to identify, proactively reach out and support those people with personalized treatment plans and the hands-on guidance they need to realize better health outcomes and improved quality of life.
What is Care Management?
Care Management is an essential component of Premise Health’s Connected Care+ approach that leverages powerful data insights to proactively identify and engage members who need support the most. This solution ensures high-cost, high-risk members receive holistic care to effectively manage their health. Through proactive outreach, personalized treatment plans and hands on support, care teams are able to empower members to improve health and close care gaps.
Care Management makes getting the right care at the right time easier for members. With a team to rely on, deferring care is a thing of the past. This high-touch strategy meets members where they are, generates better outcomes, and supports members throughout their care journeys.
The components that power our Care Management solution include:
- Pinpointing population segments – Care Management data analysts use multiple forms of data, including medical and pharmacy claims, to understand the top cost drivers for every organization and identify perennial high-cost, high-risk members. By identifying these members on the front end, teams can create tailored strategies so both employees and their dependents receive proactive support for their unique needs.
- Proactively engaging members – If you have numerous members dealing with multiple chronic conditions, or if your people need help navigating the healthcare system, highly trained care specialists support them along the way. By reaching out and engaging those who need care the most, members feel empowered knowing they have a trusted partner they can count on throughout their care journey.
- Designing care roadmaps – Care Management provides a holistic approach to helping members manage their care. Highly skilled providers and care specialists work together as a team to support members, taking the time to develop relationships while investing in their overall health and wellbeing. From behavioral health to lifestyle medicine and underlying health challenges, members experience the safety that comes from regular check-ins and a personalized, evidence-based treatment plan delivered by an integrated care team. In addition, care specialists provide ongoing support and continue follow-up care digitally (by phone, video, or secure message) or physically (in-person on campus or nearby).
- Measuring success – Data analysts close the feedback loop and keep organizations in the know. By tracking return-on-investment and measuring member health outcomes – care teams make sure members are benefiting from a seamless care experience that’s helpful, not a hassle.
What are the key benefits?
Care Management provides a robust picture of a population’s healthcare needs. Care teams discover who to focus on, why they’re struggling, and help members get to the root cause of their health issues. By helping members make informed decisions and showing them ways to invest in their healthcare journey, they’re more engaged in their daily lives and experience higher levels of fulfillment.
Implementing a Care Management solution delivers value that:
- Lowers healthcare costs
- Improves health outcomes
- Promotes a healthy, thriving culture
- Engages members in their healthcare journeys
- Gives members support and tools to take control of their health
- Delivers exceptional member experiences
The bottom line is this, when your people live healthier, you save more.
Optimizing care for your population.
Leveraging data insights to proactively engage and enhance overall quality, experience, and value of healthcare is key to Premise Health’s Care Management solution. Our innovative take on population health helps members access high-quality care while delivering significant savings for employers and optimal outcomes for members.
Learn how Premise Health can help optimize the care of your employees. Contact us today.