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Reining in Costs by Closing Care Gaps: Next Steps for Payers

The COVID-19 pandemic led to an unprecedented drop in preventive care visits in 2020, which will have lasting effects on healthcare outcomes and costs.  

 In March 2020 alone, appointments for screenings for cancers of the cervix, colon, and breast fell 86% and 94%, according to one estimate. As a result, patients are at greater risk of developing poor long-term outcomes, incurring higher-cost treatments, and increased emergent care. The National Cancer Institute predicted nearly 10,000 excess deaths over the next decade from breast and colorectal cancer alone. 

 While healthcare organizations can’t travel back in time and change the events that triggered care gaps, there’s still an opportunity to curb 2021’s healthcare reckoning. Payers can do their part by improving three things: collaboration, member engagement, and technology.   

Collaboration 

It’s not a new idea, but payers and providers need to collaborate even more over the next few years to regain balance between acute/emergent care and preventative care. There are several ways to do this. One is utilizing communications tools (e.g., ADT notifications) to ensure that transfers of care are communicated in real-time, ensuring care partners are on the same page. Health plans can also work closely with providers to share clinical data for the purposes of planning or enhancing preventive care coverage – for example, screenings for individuals ages 45+ at higher risk of colon cancer or diabetes.  

Member Engagement 

Most health plans make efforts to reach out to their members to inform them of new services, such as vaccination clinics, or to remind them of age-related health screenings. But the way a message is communicated is as important as the message itself when it comes to engaging patients – that is, motivating them to participate in improving their own outcomes.   

Health plans can do their part by reaching out in their members’ preferred communication modes (e.g., email, text, voicemail) in their preferred language. They can also make it easier for members to reach out as needed, e.g., by improving web-based messaging applications or offering easily available links to health resources such as support groups.     

Technology 

 Communications technology can support health plans by ensuring patients receive the care and attention they need exactly when they need it, in real-time. This proper communication process eliminates the need to fish for data or learn about a high-risk patient’s admission to the ED hours after the fact.  

 Having essential real-time information when it’s needed also supports the “Quadruple Aim” of healthcare — 2020’s update to the “Triple Aim” concept — which emphasizes the importance of quality, value, and cost savings, while reigning in physician burnout. When physicians and payers are in the loop about their patients and have access to all critical information at the point of care, informed care decisions will follow and patients will be better off for it.  

 Enhancing preventive services will be essential to getting caught up in 2021 and 2022. While this will present new challenges for all stakeholders, with the right collaborative partners, engagement strategy, and technology solutions, it’s possible to dramatically close care gaps triggered by the pandemic.  

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