I’ve heard it said (by a health plan chief medical officer) that health plan care management can’t impact the quality and cost of care for a member. Since joining Collective, I’ve learned that our health plan partners are dispelling that myth.
As expected, plans derive great value from the real-time understanding of where and when members are accessing the healthcare system. Coming from a health plan background, my team and I knew who our most complex members were. However, by the time we learned they were accessing the system, it was too late to have an impact.
What I’ve learned since joining Collective is that many plans are eager to collaborate with network providers. Plans have a wealth of information about their members that benefits providers when presented at the point of care. I argue that plans have the most comprehensive, longitudinal record of their members accumulated through claims data, health risk assessments, population health analytics, and member outreach activities. Yet, traditionally, they’ve lacked the tools needed to get that information to the provider in a meaningful way.
Web-based portals are the most common approach to communicating with providers. However, these portals require logging into a separate application. Since this information is not in the provider workflow, it’s seldom accessed and has little impact on the member’s care.
Collective enables health plans to collaborate in a way that’s embedded in both the plan’s and provider’s workflow through quick, automated messages shared across the provider network. Health plans can leverage this to share information such as enrollment in a care management program, assigned PCP or care manager, evidence of chronic conditions, and gaps in care or coding.
Care insights are used to communicate summarized key details of a care management plan. Providers benefit from this information as they develop their own care plan. In some cases, Collective health plan partners are logging hundreds of care insights each month.
While it may have been true that plans traditionally lacked the ability to influence quality of care in the days of lagged claims data, fax, phone, or no communication with providers and paper medical records, that is no longer the case. Times have changed, and health plans are seeing real outcomes through collaborating in a bi-directional manner with network providers via the Collective platform.
For more information on how health plans can leverage real-time information and communication, download this white paper.
Michael Keyes, MBA, PT
VP, Health Plan Business Development