How Digital Care Navigation Improves Chronic Health Outcomes
August 14, 2024
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Chronic conditions and co-morbidities like diabetes, hypertension, heart disease, and cancer are among the most prevalent and costly health conditions, particularly when poorly managed. These conditions are often associated with ongoing medical attention, frequent hospitalizations, and extensive treatment, leading to significant healthcare expenditures — particularly when members don’t receive needed care, medications and additional support to help them manage these complex conditions. In fact, according to the Centers for Disease Control and Prevention (CDC), 90% of the nation's $4.5 trillion in annual healthcare expenditures are for people with chronic and mental health conditions.
Members with chronic conditions are especially vulnerable to high rates of preventable hospital and emergency room utilization. These individuals often struggle to navigate the complex healthcare system, adhere to treatment plans, and manage their conditions effectively. As a result, they are more likely to experience complications, adverse events, and poor health outcomes, which translate into higher costs for health payers.
Given these challenges, health payers, and the healthcare companies that support them, have a strong financial incentive to implement effective care navigation solutions for chronic conditions to improve outcomes and reduce costs for these high-risk, high-cost members. Care navigation involves a range of strategies to help members and their support systems navigate the healthcare system throughout the year, access appropriate care and services — including care managers and providers of all types — and manage their conditions more effectively. By investing in data-driven, personalized HIPAA-secure care coordination programs powered by digital technologies, healthcare companies can significantly improve outcomes and quality of life for members with costly chronic conditions while also bending the healthcare cost curve and gaining a competitive advantage in the market.
Well-designed care navigation programs create strong ROI for payers by reducing hospital admissions, readmissions, and ER visits for members with chronic conditions. For example, a top 5 health insurer’s care engagement and coordination program uses predictive analytics to identify high-risk members and provide personalized care plans, while another's program focuses on coordinating care for those with chronic conditions through in-home care, transportation, and medication management.
In addition to financial benefits, effective care engagement enhances member experience and satisfaction by providing personalized support. However, typical programs guiding members to third party applications and portals often suffer from low engagement, limiting their impact. Healthcare needs new approaches to identify and engage high-risk members, such as leveraging data analytics and AI to stratify risk and target interventions — and offering interactive digital education, support and guidance to support members until they take needed critical actions.
Digital care management solutions, like remote monitoring and virtual care, can extend the reach and impact of care engagement by enabling ongoing support between traditional visits. Personalized engagements with omnichannel outreach through frictionless application-like experience strategies can drive higher engagement rates by meeting members where they are. By connecting fragmented care teams and data across the healthcare ecosystem, single, integrated digital solutions facilitate more coordinated, efficient care delivery.
As payers face the growing chronic condition burden, investing in data-driven, digitally-enabled, frictionless healthcare navigation support will be a key strategic priority to improve outcomes and reduce costs. Check out this video featuring an example of welcoming new members to their diabetes care program and refilling their medication.
To effectively address the challenges posed by chronic conditions and rising healthcare costs, payers must adopt HIPAA-secure care navigation and communication models that incorporate several key elements:
Stratify members by risk level and likelihood to benefit from interventions, using surveys such as digital Health Risk Assessments (HRAs) to capture valuable behavioral data on members' health conditions, health history, and needs and behaviors.
Tailor messaging to a member's status and channels of choice to drive higher engagement rates. This might include using a combination of phone calls, live and AI-powered chat, text messages, emails, carrier home pages, QR codes, and mobile app notifications personalized to each member's communication preferences and needs.
Recognize and address the significant impact of Social Determinants of Health (SDOH) at the members' moment of need in wellness, prevention, and chronic condition management through community partnerships that connect members with resources for housing, transportation, food security, and other social needs. Understanding member status across these factors is critical to providing needed support in innovative ways, or the knowledge gap becomes a barrier, blocking healthcare delivery and negatively affecting health (medical and behavioral) outcomes.
Assist members with scheduling specialists and sourcing resources outside of their plan. Offer high-touch, personalized support from care managers who build trust and guide members to appropriate resources, serving as a single point of contact for members and helping them navigate the complex healthcare system. According to Forbes, 66% [of consumers] expect companies to understand their unique needs and expectations across channels.
Proactively guide members to relevant and engaging educational material to deepen knowledge of chronic conditions and the importance of adhering to treatment plans, attending appointments with specialists and managing their conditions effectively. Deliver resources throughout critical care journey touchpoints, and look to partners that enable rich media, customizable CTAs and accessible language to improve health literacy.
Chronic conditions pose a costly challenge for health plans, requiring live outreach from care management teams as well as manual processes, outdated systems and strict regulations, making it even more difficult to achieve operational efficiency. Implementing digital solutions that connect the member, care team and health providers can facilitate easy access to care plans and other resources via secure messaging and information sharing. Solutions like Ushur’s, frictionless, responsive Customer Experience AutomationTM (CXA) platform enables health plans to proactively guide members to educational material, appointment setting, health needs assessments, care coordination, and data collection through convenient and preferred digital channels to vastly improve member engagement and lead to better health outcomes.
Focus on continuous quality improvement and member feedback through proactive and periodic digital Net Promoter Score (NPS) and member experience survey outreach, assessing member perception of their care navigation and care delivery experience to identify areas for improvement.
By incorporating these key elements, payers can design and implement healthcare coordination models that effectively engage members, improve outcomes, and reduce costs for those with chronic conditions. As the healthcare landscape continues to evolve, investing in data-driven, digitally-enabled, and member-centric care coordination will be essential for payers to remain competitive and deliver value to all stakeholders.
As chronic condition prevalence and costs soar, healthcare companies must abandon fragmented traditional communication and care models and invest in data-driven, personalized care navigation programs to generate ROI and improve member quality of life. The most successful models will integrate advanced analytics, omnichannel engagement, and effective care coordination to deliver proactive, holistic member support. By leveraging digital tools to connect data and care teams, payers can address both medical and non-medical needs. Payers and other healthcare companies that master care navigation for high-risk members will gain a competitive edge in bending the cost curve while enhancing outcomes and member experience in the evolving healthcare landscape.
Ushur's healthcare automation solutions empower payers to deliver personalized, proactive care navigation at scale. By providing AI-powered digital experiences, omnichannel engagement, and seamless integration with existing systems, Ushur enables payers to identify and engage high-risk members and improve health outcomes while reducing costs. With a track record of delivering measurable results for leading health plans, Ushur has specially designed solutions for Care Navigation for Chronic Conditions.
