Breaking barriers: How care management can bridge the gap in health data access

The growing need for whole person health support

Increasingly, individual health needs to be approached holistically as opposed to episodically. Individuals, providers, payers, and other stakeholders now recognize a broad definition of health that goes beyond clinical diagnoses to encompass the emotional, social, and environmental factors that impact personal wellbeing. The U.S. Department of Health and Human Services found that the social determinants of health (SDOH) have a major impact on health and quality of life while the U.S. Surgeon General has specifically prioritized awareness of mental health and advocated mobilizing the health sector to better understand and address mental health challenges.

Capturing and using holistic health data is more important than ever, but many health organizations are pondering where to place responsibility for this task. One option is for care management organizations within payers to expand their remit, evolving their capabilities to include utilizing member data to create a broader picture of each member to better support whole person health. This would allow them to deliver a better member experience, and may also have a carryover effect on provider health organizations that could increase patient satisfaction and improve their HEDIS ratings.

Payers can tackle health data challenges

Payers occupy a unique position in the healthcare ecosystem given their access to member information. This includes longitudinal claims and diagnosis data, significant demographic data including addresses, and potentially extending to employment history. With new tools available to synthesize data, analyzing these inputs can support more personalized, proactive, comprehensive care management.

Opportunities presented by data-driven care management

Among the lessons from COVID-19 was the value of data in the development of outreach plans and patient education materials, particularly for vulnerable or hard to reach populations. Those insights led many payers to invest in advanced data analytics to better understand, segment, and serve their members. Sophisticated data-driven care management strategies are an innovative tool to attract new members, improve member engagement and health, and lower cost of care. However, according to a McKinsey study, care management data and the potential it holds are vastly underutilized.

Challenges to strategic data management

Despite these opportunities, payers face numerous hurdles in their efforts to collect, normalize, analyze, use, and maintain vast amounts of health data. One initial barrier is cost. Although cloud-based solutions have reduced the investment required for data storage, it can still represent a meaningful budget expenditure. Leaders in payer organizations will need to work with their finance, IT, and medical teams to develop an investment plan, including a way to measure returns on investment in strategic data management.

An additional barrier is analytic capacity. Payers could overcome this hurdle by redeploying advanced data capabilities within their organizations to seed new care management analytics. Or they could retain external talent: The U.S. Bureau of Labor Statistics estimates that data science employment is expected to grow by 35% over the next few years.

Finally, in developing personalized care management insights, payers must decide what data is most helpful, and how best to use it. Fortunately, payers already have access to vast amounts of data that can be reorganized to generate meaningful new insights into various populations. Understanding the existing data is critical to organizing it into the best, most useful format for analysis. From there the challenge is to identify gaps in the data and design a plan to address any shortfalls. In order to enhance current datasets of non-clinical data (such as barriers to care access and cultural preferences regarding provider interactions), payers could use external data firms to help generate a holistic understanding of member health.

Care managers are key to data generation and utilization

The best data analytics can only get you so far when seeking new insights. Datasets will need to be dynamic, continually updated, and refined. Care managers, given their direct connection to members and member firms, will be key in accomplishing these goals. Care managers could play a unique, dual-role. They both use data to personalize outreach and engagement strategies and create data gleaned from interactions with members.

Fortifying the frontlines of data-driven care management

Payers and care managers already identify individuals or groups that could benefit from personalized outreach or education. An example is members who have been diagnosed with type 2 diabetes but who have not yet accessed recommended patient education materials.

Next, care managers can be trained to better understand the concerns of members in managing their health. Identifying potential barriers through surveys or 1-on-1 interactions can generate valuable non-clinical data that can be used to craft personalized strategies and enhance analytic models. For example, some members might be struggling with a lack of transportation, language or education barriers, or unreliable access to healthy food, all of which could be limiting their ability to follow recommended guidance and adopt healthier habits.

According to the World Health Organization, SDOH account for 30–55% of health outcomes compared to traditional clinical care. The importance of non-clinical data is hard to overstate. This reality makes it imperative that payers and all stakeholders in the healthcare ecosystem have a strategy that helps them understand, document, and mitigate these indicators in the populations they serve.

Better information and member education yields better outcomes

Beyond their role as data users and creators, care managers play another critical information role: Champion of patient education. In this important capacity, they help improve member understanding of their health conditions, their confidence in managing them, and their overall satisfaction with their experience. And most crucially, this type of effective education improves health outcomes.

Providing access to education materials is especially critical as many providers do not have the time or resources to answer patient questions. A 2022 survey of over 1000 adults found that almost half (46%) stated that they still had questions after a visit with their doctor, and 20% said that questions arose after their visit. Identifying and filling in these information gaps is crucial both to member satisfaction and compliance with provider recommendations. The role of care managers could be expanded to combine data management with effective member education, allowing payers to close the information gap with targeted education materials that translate to healthier members and lower overall cost of care.

The healthcare ecosystem continues to evolve, as do the responsibilities and opportunities for stakeholders like payer organizations. With strategic investments in data strategy and technology, payers can deliver holistic care management and become more integral, trusted partners to their members. An innovative, data-driven approach to member engagement and education can help payers prioritize whole person health services and deliver the personalized care management that members desire and to which most respond positively.

Learn more and download our whitepaper, Filling the healthcare education gap: A care management opportunity.