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3 Tips To Improve Health Plans’ Chronic Conditions Management – MedCity News


As the number of Americans with chronic conditions continues to grow, health plans are constantly trying new approaches to meet their condition management goals with fewer resources. Payers are seeking to optimize outcomes while minimizing costs by implementing innovative strategies like telemedicine, remote monitoring and personalized care plans. 

On Thursday, leaders from across the industry shared their advice on how health plans can do a better job of achieving their goals for chronic management during a virtual panel held by Bright Spots in Healthcare. Below are some of their panelists’ main nuggets of wisdom.

Use data analytics to identify high-risk individuals and provide targeted interventions.

Most insurers are aware that the U.S. has the highest rate of maternal mortality among all industrialized countries. Reetika Kumar, vice president of market clinical solutions and pharmacy services at Independence Blue Cross highlighted an initiative her company launched with the University of Pennsylvania to address this problem.

Under the program, called HeartSafe Motherhood, Independence Blue Cross used data analytics to determine which maternity patients were at high risk for developing preeclampsia. These patients were sent home with blood pressure cuffs and enrolled in a telehealth program in which they could talk to their provider via phone. Their providers would review their digital readings and intervene if they noticed spikes in blood pressure, Kumar explained.

She highlighted HeartSafe Motherhood as an example of a program that not only has potential to lower mortality and morbidity rates compared to traditional care — but also one that can be scaled up or applied to different patient populations relatively easily.

Centralized observation is a mighty tool.

Health plans should be taking advantage of the sophisticated remote patient monitoring tools that have been entering the market over the past decade, pointed out Scene Health CEO Sebastian Seiguer. 

These tools can be applied to the inpatient setting, such as by giving ICU patients wearables that quickly notify their care team when a cardiac or respiratory failure occurs. They can also be applied to patients managing their chronic conditions at home — so that providers aren’t left in the dark about a patient’s progress post-discharge — Seiguer explained.

Overall, centralized observation allows providers to react more quickly and efficiently to patient needs, which usually means improved patient outcomes as well as reduced costs, he explained. 

Use the right metrics.

When measuring progress on their chronic conditions management goals, health plans can sometimes fixate on the wrong metrics, Seiguer noted. For instance, health plans often pay close attention to refill metrics, he pointed out.

“You can spend a ton of money to get people to refill medication, but if they don’t take them or they don’t take them correctly, they’re still going to the hospital,” Seiguer declared.

Instead of dedicating heaps of money and time on pharmacy refill calls and reminders, health plans should focus more on measuring the clinical outcomes that matter to patients, such as their blood sugar and blood pressure levels, he remarked.

Photo: kate_sept2004, Getty Images



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