Health plans

3 essential tools for health plans in navigating the great resignation

Health has become the second sector of the US economy to deal with the effects of the big quit as churn rates surged late last year.

While quits among frontline workers are highest due to burnout due to COVID-19, other professionals are also leaving health care, including in health plans. Now, health plan managers need to ask, “How can we onboard new members safely and efficiently and ensure an unimpeded care journey while dealing with staffing shortages?”

For payers, this challenge has the greatest potential to negatively impact operational efficiency and care management. Not only is it harder to hire new talent to fill critical vacancies, but in an industry as highly regulated as health insurance, staffing gaps could hamper health plans’ ability to maintain processes. reviews. These gaps also limit their ability to identify critical gaps in care for at-risk members, coordinate and facilitate care, and create a seamless experience for members.

When the “organizational mindset” is lacking, the effects include a reduced ability to illuminate and understand the overall health status, needs and risk factors of new members, which can hamper the accuracy of bonuses, and insufficient support for data analysis to avoid deterioration of results.

Meanwhile, as resignation rate rise to 3% or more in many areas, this increases the pool of new members moving from one insurance plan to another, which may play a role in the record 13.6 million Americans register for market coverage during the 2021 open registration period. Therefore, it is essential that payers take proactive measures to protect and maintain the health of members.

Develop a Great Resignation Toolkit

The pressures on health plans go beyond filling vacancies in a highly competitive job market, where some employees can easily earn a higher salary with a competitor or in another industry.

Even when new employees are plugged into vacancies in areas such as customer service or care coordination, these team members may not have the community-specific knowledge to match members with the right ones. local health care resources at the right time. They also may not understand the intricacies of their work until they have spent time on the job.

With so much pressure on health plans to not only get the staffing equation right, but also to avoid disruptions in care, how can leaders create a foundation for member excellence during the Great Resignation? The tools for success include the following:

1. A culturally informed and clinically sound member onboarding process.

Such a process should incorporate understanding of how to tailor member communications and outreach based on ethnicity, race, and clinical complexity for maximum engagement. He must also be informed by knowledge of:

  • Health needs and preferences by generation
  • The social determinants of health that can have an impact up to 80% health outcomes
  • Additional benefits that matter most to the member population, such as dental coverage, transportation, or new home service offerings for Medicare Advantage members

Data shows that income, education, race and ethnicity, employment, community resources and social support all play a major role in health equity and health outcomes. As a result, the industry is more sensitive to the different ways members communicate their health status, past negative experiences with the healthcare system, and what would constitute an ideal healthcare experience.

A culturally sensitive integration experience, aided by a specific set of questions that varies by race and ethnicity, promotes more meaningful encounters that improve health. When members feel “seen” by their health plan and providers, they feel more comfortable engaging with them. This paves the way for the diversification of the use of health care by the population. Such investment is quickly becoming a competitive differentiator, as healthcare disruptors such as Oak Street Health, Health equality, Chen Med and Oscar Health advance the development of culturally appropriate models of care.

It is also essential to develop a generational model for member awareness and care management. For example, during the pandemic, some seniors expressed a greater desire to physical rehabilitation at home and followed, primary care servicesand medicine deliveryeither virtually or with the help of an on-site supplier.

2. A proactive, disease-specific approach to chronic care management.

Here, data-driven analysis that explores the care gaps most commonly experienced by members with specific health conditions can help pinpoint opportunities to improve health care outcomes. For example, at the Children’s Community Health Plan (CCHP), an HMO that primarily serves low-income families in Wisconsin, an analysis of claims revealed opportunities for more innovative approaches to behavioral health to meet the increased demand for these services during the pandemic.

He also pointed to the growing presence of costly chronic diseases, including opioid addiction and depression-related diagnoses. With this information, CCHP can design condition-specific interventions that have helped prevent members with these conditions from reaching more severe stages of the disease, including:

  • Primary Care Physician (PCP) Assignment to Members with Opioid Use Disorder: CCHP analysis showed that 24% of unique members with an opioid diagnosis code were not assigned a PCP.
  • Focus on the ability to influence members at increasing risk, including depression, many of which are women, and substance use disorders. An analysis of claims revealed five chronic conditions for which depression is most often a co-occurring condition: asthma, hypertension, osteoarthritis, birth defects and hyperlipidemia. The average cost for a member with one of these conditions is 1.3 to 5.5 times higher when a diagnosis of depression is present. By ensuring appropriate treatment of behavioral health issues among members of these cohorts, CCHP could significantly reduce risk and cost while improving member health and experience.

Another approach to consider is developing disease-specific care pathways based on evidence-based care practices. This helps provide a safety net for chronically ill members at an early stage of the disease, which helps limit the progression of the disease.

3. Tools and technologies that provide a more robust view of data.

Merely aggregating member health data is not enough – health plans need to know what to do with that data to have a meaningful impact on member health. With request for data analysts accelerating rapidly – and with data science “constant” unsubscription during the pandemic, health plans may need to invest in new technology or outside expertise. This could enhance their ability to make informed decisions about member health or benefit design.

Health plans should also focus more on building data lakes or repositories to ingest data from multiple sources and in multiple forms. This is especially critical in the age of interoperability, where health plans’ access to data from disparate sources has increased markedly.

With access to a wide range of data across the continuum of care, health plans can assess which types of conditions are becoming more prevalent among members, especially at a time when some members are skipping wellness exams or preventive screenings, such as cancer screenings, to avoid exposure to COVID-19. This view of the data can also help identify providers who have adopted best care practices and provide valuable assistance when training providers who provide less valuable care.

The Need for a Resignation Resilient Strategy

The Great Resignation intensified the pressure on the resources of the health system. Going forward, maintaining the quality of care and services will depend on proactive action and innovations in care delivery and support. By developing data-informed, culture- and condition-specific approaches, leaders can strengthen service; identify resources needed for new and existing members; and create a landscape of longitudinal members to guide success, drive impact, and ensure sustainability of engagement and health outcomes in 2022 and beyond.

RaeAnn Grossman is Executive Vice President of Population Health Management, Risk Adjustment and Quality Operations for Cotiviti.