Health plans have extensive experience with care management, technology, and pilots. However, what’s new is leveraging all three to better collaborate with providers to enhance Chronic Condition Management, engage and activate members more deeply, and facilitate overall cost savings.
Research shows that all health plans offer care management programs regardless of size, location, and ownership. And, while these payors’ “internal evaluations suggest that interventions improve care and reduce cost, plans continue to report difficulties in engaging members and providers.”
Figure 1: Care management maximizes the strengths of each partner for the member's benefit.
ThoroughCare developed its payor-enabled, provider-delivered care management strategy so that its care coordination platform can act as a bridge, leveraging each partner’s strengths (Figure 1) to improve member engagement and quality outcomes.
Why is payor-enabled, provider-delivered care management effective?
Payor-enabled, provider-delivered care management is uniquely designed to bridge the gaps between members, providers, and health plans.
Figure 2: The benefits of a payor-enabled, provider-delivered care management.
Members win through:
- Greater engagement with their care team
- Receiving care tailored to their needs
- Enhanced quality of life and member empowerment
- Tools and skills to self-manage better
Payors win through:
- Highest possible member engagement and participation
- Insights into member health trends
- Facilitating more accurate risk assessment, cost management, and evidence-based care practices
- Leveraging the trust built between members and their providers
Providers win through:
- Access to real-time health data
- Evidence-based assessments, care plans, and workflows
- Proactive team-based management of chronic conditions
- Quality and financial alignment with payor policies and incentives
What could a payor-provider care management pilot look like?
The ThoroughCare pilot program starts with payors, who then offer the pre-configured platform to their providers. There is no cost for the pilot program for the first six months. This allows both partners and ThoroughCare to gather clinical, quality, operational, and financial data that can be used to benchmark progress toward goals.
With more than 755 care delivery organizations using ThoroughCare, our pilot program leverages care management as an opportunity to bridge payors and providers for improved member engagement and outcomes.
Figure 3: How ThoroughCare acts as a bridge for payor-provider collaboration.
As shown in Figure 3, the ThoroughCare platform acts as a bridge, enabling payor-provider collaboration where the platform uses data feeds and input as part of any care management program and provides a variety of output that can be used for engaging members.
Our team’s extensive provider adoption experience enables us to support collaboration through technology and services already in place.
How ThoroughCare supports a successful care management pilot
ThoroughCare has more than a decade of experience successfully launching provider-driven care management programs. This experience uniquely positions us to work between payors and providers to ensure both achieve the goals most important to them.
Four factors set up a care management pilot for success. The ThoroughCare team equips payors to partner with providers and members in a new approach to care management.
Purpose: Program development considerations
Clear objectives are paramount to a successful pilot. Having focused goals to improve member health outcomes, engagement, or satisfaction enables excellence in the other three areas.
Crisp and realistic goals are critical because they dictate which metrics to benchmark based on what the payor and provider deem defines success.
What are the health plan’s motivations for launching the pilot and why would key physicians in the payor’s network want to join? What member outcomes would be worthwhile and deem a six-month pilot impactful?
Rank order possible priorities for pilot outcomes, including:
- Quality improvement
- Preventive health adherence
- Care gap closure
- Chronic disease management
- Lessen current and future member risk
- Decrease high-cost utilization
- Test innovative value-based care arrangements
- Ensure innovations concretely address business needs
Game plan: Program launch playbook and support
Pilots that drag on and don’t evolve in real time tend to die on the vine. It’s critical to have a playbook to guide implementation so stakeholders are on board, clear roles are established, and team members receive useful and timely training.
ThoroughCare created an interactive 120-day playbook to guide each client’s launch. It’s a complete guide to starting and growing a new care management program, providing step-by-step support for all the necessary elements key to success. The playbook is combined with ThoroughCare’s Clinical Services to help de-risk new care management program launches and pilots.
Armed with robust analytics, dashboards, and reports, collaborators can anticipate how a pilot might continue after six months, evaluate the initiative against benchmarks, and look for opportunities to scale success further.
Tools: Seamless collaboration, coordination, and communication
ThoroughCare provides a fully pre-configured and EHR-integrated platform workflow that makes care management easier for payors to launch and providers to implement.
Because our platform was built for multiple team-based care management programs, it offers essential features and functions needed to meet a variety of clinical, operational, financial, and quality standards. These include but are not limited to:
- Evidence-based assessments
- Care planning tools and action
- Motivational interview and goal planning
- Evidence-based education for staff and members
- Integrated data and interoperability
- Analytics across clinical care, operations, performance, and finance
- Task management, time logging, and compliance
- Coordination and communication across teams
Outcomes: Robust metrics and reporting
Analytics and benchmarking connect the pilot’s purpose to its outcomes, ensuring that care management interventions and activities focus on measures that are meaningful for members, providers, and payors.
ThoroughCare’s robust analytics enable near real-time insights derived from a host of sources, including:
- Personalized care plans
- Electronic health records
- Health information exchanges, including ADT and CCDA records
- Remote monitoring devices
- Advance care directives
- Mobile applications
- Member interactions, assessments, and touchpoints
Dynamic dashboards and reports cover five key performance areas, including:
- Strategic data
- Clinical data
- Engagement data
- Financial data
- Operational data
Equipped with dynamic and accessible data analytics, pilot leaders can capture early successes and iterate on improvement areas, leading to a more fruitful collaboration.
Explore the potential of payor-enabled, provider-delivered care management with ThoroughCare
Working together, our team helps health plans evaluate a new approach to care management that maximizes the payor’s strengths while leveraging the rapport, trust, and personal relationship providers have established. Through a mutually rewarding collaboration, payors and providers can maximize their impact while achieving their most desired goals: increase quality, lower cost, improve outcomes, and enhance member engagement.
