Health plans can achieve optimal results for at-risk members by using a mixture of data, analytics, business intelligence, and efficient clinical workflows. Mapping SDOH at the census-tract level, finding opportunities to impact populations of members who live close by with the same issues, and developing programs for effective outreach in the community are critical.

4) Members’ Expectations
Healthcare consumers have grown to expect the technological capabilities that impact the way they shop, engage with financial institutions, and interact during personal relationships. Some like to talk by phone, and others want to engage solely online. Those partial to digital engagement still have preferences regarding how they use technology to interact with the rest of the world, and care managers seeking to improve outcomes need to adapt their tools and approaches accordingly.
Health plan care managers are in a great position to help members take advantage of available resources and services to support maximum health at a lower cost, but they need the right tools to successfully assess where a member is in their healthcare and put them on the proper care pathway. Individual- and population-level communications that leverage AI and prescriptive analytics capabilities allow care managers to manage, document, and report on members’ care adherence and outcomes. Once they have implemented the proper IT, it is up to the care manager to develop and execute best practices to ensure closed-loop communications such as:

• Follow up outreach using the member’s preferred communication channel
• Options to use portals and apps for self-management and health education
• Texting prior to planned phone discussions to increase appointment adherence
• Use of digital language translation services

Maximizing efficiency
Kathleen Ellmore, Co-Founder and Managing Partner of Engagys, says that her clients are looking for help so that they can touch more members and be more effective with their engagement strategy.

“In our work at health plans of all sizes across the country we see Care Managers who are frustrated because they are not given sufficient time to do what they do best – actually deliver care. Instead, they are saddled with administrative duties and primitive tools. Their demands are simple: provide them with adequate capabilities and seamless transitions into multichannel interactions including SMS text messaging, because it:

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