Improving patient/member engagement for value-based performance: Why relying on technology is more important than ever

Revenues related to value-based care contracts are growing. The latest data shows that 14% of healthcare provider reimbursements in the United States are tied to capital risk models, compared with just 7% three years ago. At the same time, changes in federal policy—particularly around Medicaid eligibility and program continuity—are adding new urgency to efforts to actively engage patients in care.

As financial risks increase, many healthcare organizations face the challenge of activating scalable and consistent patient engagement across large, diverse patient populations. One of the biggest barriers to value-based performance occurs when healthcare organizations strive to help patients take the right steps to improve their health. This is especially true when provider organizations must determine how to connect with members who have never had contact but are assigned to a physician group through a managed care health plan.

This is an area where health plans and providers can work together to better leverage technology and data analytics. Advanced solutions for creating targeted communications will enable healthcare organizations to increase annual screening rates and enhance continuity of care. Additionally, tools that provide providers with critical information can better prepare for upcoming patient visits and help facilitate better discussions between providers and patients to maximize limited time and close gaps in care.

The power of data-driven engagement

While health care leaders acknowledge the growing momentum for value-based care, a 2024 Advisory Council survey shows provider readiness remains a critical issue when it comes to resources, capital and consistent executive alignment.

Technology remains at the heart of preparedness, and the use of data and analytics, including the support of artificial intelligence, will continue to be an important driver of the success of sustainable risk-taking strategies. That’s why leading providers and health plans are turning to population health platforms that integrate with electronic medical records and offer advanced capabilities to drive adoption.

For example, when a patient has not had a health checkup for more than a year, an alert is triggered in the population health management platform. Patients automatically receive a series of carefully crafted secure text messages encouraging them to book an appointment via phone or with an appointment link.

Additionally, this type of automated outreach ensures patients don’t miss important timeframes for Medicaid redetermination and health plan re-enrollment. As federal guidelines continue to evolve and patients take on greater responsibility for maintaining their medical coverage, having automated, near-real-time outreach capabilities is no longer optional—it’s critical to keeping individuals connected to care.

If a health plan member is assigned but has not yet established a care relationship with a provider, personalized text reminds the member of their health plan benefits and offers assistance in scheduling a visit. Once a visit is scheduled, patients automatically stop receiving messages thanks to data integration with the EHR. If the patient does not show up for the appointment, the messages will start again.

This “set and forget” solution ensures staff don’t have to manually move data between tools or call patients to interact with them. It also taps into a tool most American adults already own: a cell phone. According to the Pew Research Center, 98% of adults own some type of cell phone, and 91% of them own a smartphone.

Get better outcomes with patient access programs

As healthcare adopts value-based care, data-driven, targeted patient services can help close gaps in care that impact performance. Along with this more proactive engagement, healthcare providers should also leverage technology that supports patient visit planning to ensure time with patients is thorough and optimized.

Care team members with daily patient and appointment-specific information can come together in the morning to identify, plan and prioritize each patient's needs to be addressed. Alerts ensure providers don't miss due immunizations or screenings, preventive services like cancer screenings or A1c tests, and critical timelines that ensure continuity of care like Medicaid redeterminations and health plan re-enrollments. The right solution can also identify patient risk factors such as smoking, obesity, mental health and social challenges that may impact care and treatment decisions.

Proactive patient visit planning allows busy healthcare providers to intervene earlier in the treatment of chronic conditions, reducing the need for more intensive treatments later and avoiding prolonged hospital care. For example, one general outpatient and inpatient hospital in the Midwest used tools to support pre-visit planning and addressed nearly three times more diabetes A1c and depression screening gaps than without daily guidance.

Technology plus collaboration for better VBC results

As risk-bearing contracts represent an increasing percentage of total revenue potential, providers and health plans must work together to achieve and maintain a healthy bottom line. Targeted outreach and more proactive visit planning to optimize time between providers and patients will be important factors in setting the right foundation for success. Health plans and providers that adopt a technology-driven, collaborative approach will achieve higher clinical quality measure performance, risk adjustment factor recapture rates, and cost savings while producing better health outcomes—a win-win for everyone involved.

Source: metamorworks, Getty Images

This article appeared in Medical City Influencers program. Anyone can share their thoughts on healthcare business and innovation on MedCity News through MedCity Influencers. Click here to learn how.