With increased regulatory pressures, changing payment models, and growing complexity, payers are looking to digital health solutions to improve quality and outcomes, boost their performance, and stay profitable. In fact, 62% of health plan leaders say that investing in modern technology for digital transformation is the top way to achieve their organizational goals in the new year.
In a recent AMC Health webinar, "Better Quality, Better Revenue: How Payers Are Embracing Digital Health Within a Shifting Payment Landscape," our experts explored the impact regulatory changes are having on plans, why rethinking quality is critical, plus, key considerations for evaluating digital health solutions.
Over the past year, Medicare Advantage plans have been inundated with increased regulatory demands and changes that are leading to concerns about costs, performance, and revenue. Changes to Medicare Part D, Star Ratings, risk adjustment programs, and interoperability requirements, for example, are leading payers to raise questions about how to be successful with quality, meet regulatory expectations, and stay profitable. Add to that CMS’ prioritization of health equity, and plans are also trying to figure out how to ensure their quality programs have an equitable focus and support members who are most vulnerable, and often, most costly.
In the midst of a challenging payment landscape, health plans are paying closer attention to the ROI of their programs and becoming more creative in their approaches and more targeted in regard to where they put their resources. Here, our experts explored ways for health plans to efficiently deliver services, improve performance and drive revenue, while also curbing costs.
Payers must shift their mindsets and think about quality not only as a way to support Star ratings or NCQA report cards but as a priority throughout the year and the member’s journey. They must look at ways to meet members where they are, optimize member engagement, use multiple touchpoints, and provide connected, coordinated care.
Data is critical for quality, but payers must have tools that go beyond understanding which members were recently hospitalized to avoid readmissions, to those who may be at risk for a hospitalization as well.
Predictive analytics tools can determine which members need outreach and intervention, if the provider network is adequate, and where plans should put their resources. For plans to be successful over the long term, they must prioritize gathering the right data to better understand their members and better align their interventions.
Oftentimes, payers bring together their teams to deal with certain, individual aspects of performance, such as Star measures or CAHPS questions, for example.
A more effective approach, however, is to think globally and bring together teams that solve access or member engagement. While data can certainly help align these efforts, taking a creative approach to collaboration and bringing together teams around the broader goals and objectives is key.
Digital health tools are enabling plans to gather data about their members, drive member engagement, and improve quality, but knowing what to look for is important. Here are some key considerations:
With ROI top of mind, the onus will be on quality leaders to make a business case for new digital health solutions. They will need to arm themselves with proof points and a plan to track progress and evaluate outcomes. Quality leaders also have an important role to play in helping other departments understand how they impact quality because at the end of the day, quality must be an organization-wide effort.
As payers continue to navigate increased regulatory pressures, adopting digital health solutions to improve quality and outcomes, drive member engagement, and increase revenue will be critical. To learn more, watch our webinar, "Better Quality, Better Revenue: How Payers Are Embracing Digital Health Within a Shifting Payment Landscape," or contact us today.