Value-based care requires creativity and technology partnerships

Revisiting the view of the ‘care environment’

Part of the move to value-based care may require a change of perspective on the part of health plans and healthcare organizations regarding what defines the care environment. A mindset that care ends when patients and members leave the hospital no longer satisfies the requirements of modern wellness, and care management needs to view home as an extension of the care environment for plan members.

For value-based care, that can include:

• Offering wellness programs based out of community organizations for greater accessibility and engaging with members at a local level.
• Focusing on the Food Is Medicine Initiative to promote better diet and nutrition practices to aid in the treatment of chronic conditions and chronic pain. This can include practical, easy-to-implement, nutritional tips, or assistance programs such as gift cards for groceries.
• Regular movement programs, like easy-to-maintain walking regimens or basic, at-home exercises to help keep members, particularly seniors, active to help manage symptoms of long-term conditions and reduce chronic pain. In many cases, even modest movement-is-medicine programs have not just physical, but mental health benefits as well if they can encourage members to get outside, be social, and feel more active.

Once members have left a health system, care management is often challenged because mass outreach to populations can be complicated. But practical, specific healthy lifestyle tips can deliver sustainable benefits while feeling easier to maintain for members at home.

Motivating members through incentive programs

In my experience working with employer group plans, incentive-based wellness programs can be one of the most effective ways to motivate members to participate in value-based care initiatives. However, they do present their own set of challenges.

Generally, incentive programs are tied to ongoing activities that commence following an initial health assessment to identify a member’s risks and set them on a path of flexible programs based on their needs. Incentive credits are often awarded for completing tasks such as walking exercises, other simple fitness activities, or for taking preventive health measures like getting your annual flu shot or monitoring your blood pressure.

These programs are usually only successful if the eventual reward for completing these activities is more substantial. Let’s face it: a $25 gift card is maybe not enough to get people to do the activities you’re hoping they will do!

Even with a successful incentive program that draws avid member participation, another challenge can be measuring outcomes. Just because they are participating, is it proving to be cost-effective and resulting in better overall member health?

Data drives outreach for value-based care

Whatever methods care management programs devise to take a long-term, value-based approach to member wellness, data is essential to understanding a member’s rising risks, and therefore, the programs that should be targeted to them.

One of the challenges that health plans face is that there actually is so much data available around individual patients or members, they can usually see their risk developing in the data. The question then is not what do you help them with, but how do you engage that person and at what time?

For value-based care, much of the benefit in mining member data is for social drivers of health that might impact access to care or affect a member’s ability to maintain at-home wellness, nutrition, and movement plans. Knowing where there are potential barriers allows care management to plan for ways to address those challenges.

Data can also be key to uncovering preferences on communication. We tend to assume that everybody wants digital outreach because we’re in the digital age. But, when we know through data that some people prefer direct communication over the phone and some people prefer mailers, care management has a better understanding of how to engage them and a better chance of success.

UpToDate Guide: A three-tiered approach for value-based care management

To help payers and care management teams streamline their transition into a value-based care model and optimize their data and programming, UpToDate Guide care management solution provides customized, scalable outreach and member education with opportunities to support value-based care initiatives at three levels:

1. Care management support (targeting high-risk members)
2. Member population outreach (targeting rising-risk members)
3. Member self-service resources (available to all members)

Care management support

By integrating trusted UpToDate member education and interactive content within existing care management platforms through SMART on FHIR technology, allows care managers to easily assign and send relevant materials directly to members without disrupting their existing workflows. It simplifies follow-up and skill-building for members, and it’s very easy for care managers. Our partnership with care management platforms like ZeOmega enables deeper integration with payer workflows.

Member populations outreach

UpToDate Guide allows batch delivery of educational materials and interactive videos to a cohort of members through care management platforms as part of population health initiatives. These type of wellness campaigns can be used to target people who are at risk for chronic conditions, to promote healthy habits, and to support mental health.

Member self-service resources

UpToDate Guide content can be used to create different self-service libraries and portals on a health plan-supported site or app, enabling members and caregivers to do research, making it easy for them to find the specific programs and content that they need.

Evaluating success of value-based care initiatives

UpToDate Guide supports care managers by making it easier to track member engagement with programs and materials deployed through solution integration. It also allows payers to gather feedback on whether members found value in the programs and if they are inspired to take action as a result, providing a closed loop on both the care management and the population health initiatives.

Combining that feedback with claims analysis of services, payers can track ongoing progress of how value-based care programs are impacting their membership base.

In one such study to evaluate a hypertension awareness program, the participating organization found that people who engage with the programs were more likely to not only get their blood pressure checked, but to make lifestyle changes to help maintain blood pressure in a healthy range.

Being able to see that sort of result is huge. At the end of the day, you know members are being incentivized to move toward the longer-term healthy decisions, rather than just specific procedures. And you know there are things care management could do to focus on helping people be aware of health risks, address them earlier, and help manage risks before they become a more serious health crisis. But the challenge is trying to tie all of those activities to tangible results. When you can tie your work to both member satisfaction and visible measurements, these are important steps.

Learn more in our eBook “Unlocking the potential for smart payer care management.”