Reduce Denials with These Four Tips to Uncover Hidden Coverage
A recent report by The Kaiser Family Foundation showed that claim denials are on the rise, with some plans reaching up to 80% in denials. Based on...
Our lives changed significantly during the pandemic—lost jobs, cross-country moves, pay cuts and lost or changed health insurance. Healthcare behavior also changed. A survey released by the Prevent Cancer Foundation found that 43% of people surveyed had missed preventive care appointments during the pandemic. In the three months after lockdown measures were first imposed, Epic Health Research Network found that screenings for breast, colon and cervical cancers had declined by two-thirds.1 This is significant for health plans, who are already beginning to see the costly effects of skipped appointments. That’s why it’s important for health plans to know and engage their members.
Read on to learn three ways Social Determinants of Health (SDOH) data helps health plans succeed.
- Data helps health plans understand a member’s level of risk and address their needs with targeted interventions.
With the right data, it’s possible to get an all-encompassing view of members, including factors that go beyond medical charts. For example, if a health plan knows a member lives in a food desert and doesn’t have reliable transportation to buy nutritious food to keep their diabetes in check, it may be able to intervene. Perhaps it can identify a community food pharmacy program for that member to enroll in or provide them grocery delivery services. - Data helps improve health inequities and reduce medical costs.
When health plans have social risk data on their members, they’re better able to develop outreach strategies that drive better health access, services and outcomes. A more focused approach to closing these inequities may also help reduce costs. For example, AmeriHealth Caritas DC, a managed care plan in Washington D.C., struggled with costly hospital readmissions and unnecessary emergency room visits among the homeless population it served. By partnering with local organizations, the health plan was able to launch medical respite facilities to give patients facing housing instability a safe and supportive place to heal after hospital discharge. - The right data can help you engage with your members.
Engagement starts with making genuine human connections. When you know your members, you can look for the right times and right ways to reach out to them. One of the single best ways to impact loyalty is to meet your members where they are at. When a major life event happens or there’s been a change in health, react, connect and advise your members. SDOH data helps health plans make strategic engagement plans that often lead to meaningful conversations and successful health outcomes.
If a member isn’t engaged, reconsider your outreach tactics and seek to understand their preferences. If they aren’t answering the phone, maybe direct mail or email is better. Are they not responding to your mailings? Maybe you don’t have the right contact information. Twenty-six million people in the U.S. moved from their primary address in January through October 2021. That’s about 8% of the U.S. population.3 Not having the right information can result in poor member engagement, coordination and financial loss. Invest in comprehensive screening tools and technology and consider partnering with external vendors that specialize in socioeconomic data aggregation and SDOH risk mitigation strategies. Small steps can make a big impact.
When a health plan has the right data, it can develop member outreach strategies and interventions that will lower costs, advance health equity and improve engagement. And while there’s no shortage of data in the healthcare industry, it can be challenging for health plans to decipher which data to use.
Learn more about how we help health plans succeed.
Source
1. https://epicresearch.org/articles/delayed-cancer-screenings-a-second-look/
3. https://www.jchs.harvard.edu/blog/have-more-people-moved-during-pandemic
