Written by With supplemental benefits, many Medicare Advantage (MA) plans are attempting to address both the medical and social risks. The supplemental benefits include health-related services such as vision, dental, and hearing as well as services to address SDoH such as transportation, meal delivery, structural home modifications, pest control, etc. Most supplemental benefits are offered to members with multiple chronic conditions and equity gaps, and many members need multiple supplemental benefits. This makes care management more complex. The care management software of today is not effective in coordinating the wide range of services across multiple clinical and nonclinical providers.
To improve the value of supplemental benefits, health plans and care providers need to significantly enhance their care management capabilities.
Why is today’s care management technology ineffective for supplemental benefits?
The goals of supplemental benefits are to reduce the overall medical cost and improve health outcomes and member satisfaction by providing a comprehensive clinical and non-clinical support infrastructure to members with complex needs. The care management technology of today fails to turn the expected value of supplemental benefits into realities. Why? According to many health plans and providers, care management technology is:
- Dependent on outdated information to find the right members (who can benefit from these enhanced services) as opposed to real-time data that can dramatically improve member identification, and enhance care coordination, and overall quality.
- Less able to incorporate social, behavioral, and cultural influencers (such as health literacy) and socioeconomic conditions (such as food security or access to transportation).
- Siloed and nurse intensive, instead of taking a whole-person approach through an interdisciplinary team (clinical and non-clinical providers) — all working together on a tailored health plan.
- Too limited to reach and support members effectively using traditional (mainly telephone-based) outreach methods.
- Designed for infrequent interactions, that provide limited insight into members’ day-to-day behaviors, making it challenging to identify evolving member needs and effectively support members toward improved outcomes.
What is enhanced care management (ECM)
Enhanced care management (ECM) enables care teams to select “Populations of Focus” that can benefit from intensive coordination of health and health-related services to address their clinical and non-clinical needs. Enhanced care management puts the member at the center, taking a whole-person approach to supporting care. It breaks down the traditional walls of health care – extending beyond hospitals and healthcare settings into communities. Care providers from all angles — primary, specialty, behavioral, and community support— can move in lockstep with each other. They have complete visibility and influence over a member’s care plan that includes actions around medications, nutrition, mental health, and social determinants of health.
Through Sprite Health’s digital care management solution, care managers can implement whole-person enhanced care management that integrates supplemental benefits with medical care. They can easily identify members with complex needs and who are facing difficult life and health circumstances. Finding what benefits are available to each member is easy. They can create a holistic care plan that includes both clinical and non-clinical resources. The comprehensive care plans are shared with the members in the form of easily digestible, interactive daily health checklists – that includes diet plans, exercise regimens, educational videos, automatic reminders, and more – all via a user-friendly, low-friction mode of communication that members readily adopt.
The software provides integrated care coordination to help care teams identify the right clinical providers and community support organizations who can best address each and every need of the member population. Coordinating with multiple providers (medical services, behavioral health, community resources, transportation services, social and home settings, and cultural and religious centers) is easy with a single interface. With closed-loop referral processes, they can see which providers are providing value and which interventions are effective. The digital care pathways help significantly increase the reach of care management staff to thousands of members as well as the frequency of touch points. They can send brief, secure messages through the app to individual members or member segments, allowing them to deliver personalized communications on a regular basis.
With access to real-time engagement data – care managers have access to accurate, meaningful insights into members’ progress on a daily basis. With this information, they can effectively coach high-risk members to adopt healthier behaviors and intervene at the right time to change the trajectory of members’ outcomes.
The digital care management platform provides a customizable care manager dashboard that helps care managers dynamically prioritize outreach by highlighting which members require attention on a daily basis.
Results
Improved member satisfaction: With an experience that seamlessly integrates into day-to-day life, members are more willing and able to actively participate in care on a regular basis. Our mobile app makes it much easier for members to initiate contact as well as reach out to care managers at any time with questions or concerns.
Higher productivity: Equipped with smarter tools, automated documentation, and better data, care managers can amplify their reach and engage an unprecedented number of members.
Improved financial outcomes: By enabling higher-touch support, the digital care management solution helps care management teams improve effectiveness and reduce cost/ utilization among members. Through robust data capture and more intelligent outreach, plans and providers can move the needle on quality metrics that drive higher revenue.
If you’re a Medicare Advantage member and believe you qualify for supplemental benefits, you can use the plan finder to search for a health insurance plan that offers the benefits that are right for you. If you are a health plan, connect with us to learn how we can help you streamline your supplemental benefits offerings.