Healthcare organizations are seeking to engage with broad, diverse populations to secure actionable health data on everything from pre-diabetes to colorectal cancer risks. Technology can assist but must be used strategically, in a manner that meets the needs of targeted populations, and in a way that gives health organizations the information and connectivity they need to identify, build and implement programs that help them attain performance metrics and optimal reimbursement.
Of the many obstacles organizations encounter is the tendency to rely on traditional approaches and what’s worked in the past. However, as demands increase and as uncertainty rises, good enough just isn’t enough. The technology, systems and programs are available to do more and better for health plans and their members.
Screening is an important step for health plans today. It helps to identify members with health problems as well as those at risk who could benefit from interventions. It also enables health plans to engage, educate and inspire action, and it remains a key part of performance and reimbursement measurements.
The health information technology that lies behind health screenings makes the difference between success and failure. It’s not enough to simply text or email members and consider that a true integration of technology and population health management for screening. Technology platforms must provide the ability to orchestrate programs centrally. Additionally, software tools must coordinate programs across multiple vendors with ease.
Consider all that tech can automate within a screening. For example, auto-deploying kits to high risk populations at home—based on pre-established parameters, under their physicians’ (not health plan’s) name—increases participation. Analytic capabilities of the top tech platforms enable health plans to identify and utilize the communication method most likely to generate participation and to manage and track those methods, including Short Message Serve (SMS) or text, email, Interactive Voice Response (IVR), paper mail and existing health plan portals.
Most importantly, technology must be used to inform providers about the program, alert them about which patients have enrolled, and ensure they receive results quickly.
Once the technology and platform are established and built (either internally or with partners), the next step for health plans is to identify conditions to target. They can start by analyzing those conditions that are and could become significant contributors to plan losses regarding revenue, reimbursement, quality and future expenditures. These include:
Diabetes. It’s estimated that as many as 86 million Americans older than 20 have or are at risk for diabetes. Emphasis on diabetes is increasing. The National Diabetes Prevention Program encourages physicians and health plans to help members’ access screening and prevention programs. Providers that encourage screenings and involvement in prevention programs can achieve Patient Centered Medical Home Recognition, as well as meaningful use for electronic medical records. More importantly, all health plans now must cover screenings for overweight or obese adults 40 and older for abnormal blood glucose levels.
Cholesterol. While diabetes rates are troubling, so, too, is high cholesterol. It’s estimated more than 102 million Americans over 20 years old have unhealthy cholesterol levels. Additionally, at-risk and vulnerable populations, including, elderly, veterans and the indigent, have a much higher rate of non-screenings. It is here where health plans can play a greater role in more targeted screening, education and interventions that encourage change.
Colorectal cancer screening. The good news is that overall rates of CRC screening are increasing. The bad news is that, according to the American Cancer Society, colon and rectal cancers are increasing in younger adults. Simple-to-use tests that can be completed in the privacy of one’s home, such as the fecal immunochemical test, are expanding access and utilization. However, health plans often have a difficult time reaching underserved populations and encouraging follow-up action.
In fact, while identifying the health screenings to offer is becoming easier, finding optimal ways to target and engage patients remains challenging, and this is another area in which healthcare IT can help by keeping track of patient preferences. Health plans must reach elderly members with no transportation, veterans in rural areas, as well as homeless or transient populations to secure optimal reimbursement, and of course, to meet their commitment to members. Additionally, there are still populations without access or interest in using smartphones, laptops or computers.
These are the plan members that need different approaches to contact and interventions. Targeted health screenings mailed to a home or other private secure location, with clear, easy-to-follow instructions in the member’s native language, can help these segments. In urban areas, indigent and homeless populations may lack not only transportation but also technology. Partnering with community clinics, homeless shelters and even faith-based groups can help this population access health services.
Creating an effective and new approach to screenings does take time and a well-thought-out strategy. Important considerations are to:
- Tap into the big data insights provided by member health information. What disease states are the most costly to the plan? What conditions are most prevalent? In what communities? What are the demographic characteristics of those populations?
- Use cross-promotion to get the word out. Digitizing data helps health plans to better connect members with other programs offered by the health plan. Promote screenings during flu season or along with back-to-school physicals. Look at other ways you connect with members and incorporate screening outreach into those opportunities.
- Use multiple modalities of communication. It’s not a one-size-fits-all effort. Instead of robocalls, ensure call center agents and customer support get pop-up screens if a member is targeted for a health screening. Educate those team members on how to communicate with members. Use emails, texts, letters, calls—all the tools in your toolbox—but match those tools to the population segment.
- Streamline and digitize screening processes, especially at health fairs and remote screening sites. Digital data means fewer errors, faster results for participants and better integration with automated medical devices, such as those to check cholesterol. With wi-fi connection, this data can be securely and wirelessly transmitted at the site location.
- Ensure the platform you use for screening provides interoperability (e.g., connects with your EHR) and is readily configurable. Higher costs are involved, not to mention delays in program implementation, if systems, programs and platforms can’t communicate.
- Look at other technologies. With the advent of wearables, health plans now have other mechanisms to get data and engage with members. Ensure your technology partner has the capability to tap into that data and incorporate it where needed in screening and outreach programs.
- Ensure the highest level of data security. Look for vendors with the Health Information Trust Alliance (HITRUST) certification, used by organizations that create, access, store or exchange healthcare data. A growing number of health systems want their organizations and vendors to be HITRUST certified to ensure ease of communication and data security.
Look for strong personal customer service and support from screening partners so that members will have readily available resources to call if they need support or have general questions.
There are additional steps to consider. With advancements in technology, health organizations can use technology to learn from populations targeted for screenings. Predictive analytics can be used to identify patients with markers that may indicate a risk for diabetes or heart disease and implement earlier interventions.
Cost is always a factor when considering screening programs. However, targeted programs help to manage costs. More importantly, a global, long-term approach to screening helps to identify cost- avoidance potential. If we screen and implement programs now, what percent of diabetes, heart disease, and CRC can we prevent three, five and even ten years into the future? Those are important questions for a health plan to consider. Data is beginning to show the value of this strategy. Beginning in the early 2000s, a large national health plan that implemented a CRC screening program found that sending FIT tests to targeted members led to earlier detection, helping to improve interventions and saving lives.
We no longer live in a fee-for-service world. Health plans and payers believe in the principles of value-based care. Health plans that find experienced partners and look for new ways to incorporate screenings to meet their goals will be able to meet the uncertainty of the market while ensuring they provide optimal programs and outcomes for their organizations and members.
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