The Triple Aim is the holy grail for all healthcare pursuits. But given the highly complex and inter-related structure of the healthcare system, working to achieve the Triple Aim requires an integrated effort that involves all relevant parties, from hospitals and providers to the public health sector. That collaboration must also include health plans, who have a vested interest in aligning services to help achieve all three of the Triple Aims—especially as provider payments are increasingly linked to the value and effectiveness of the services that health plans cover. Below are three ways health plans can align with and advance the objectives of the Triple Aim by leaning into supportive technologies that allow them to engage differently with the members they serve.
PATH 1 | IMPROVE THE EXPERIENCE OF CARE
Healthcare is already a confusing experience for consumers, who must navigate their way through a maze of medical specialists, provider networks, cost options and coverage questions as they seek to find help for, in many cases, multiple health issues. It’s no wonder that more than 2/3 of consumers say that every step of the healthcare process is a chore. That confusion is only increasing as more and more specialized medical services and technologies become available to consumers through their health plans. Having access to more services, choices and information may be a positive, but it can often overwhelm consumers, causing them to not act at all. In fact, half of consumers today say they have avoided seeking care altogether because so much work is involved in navigating the healthcare system.
Consumers don’t need more information. They need clarity. It’s not about more choices but better guidance. Health plans must focus on simplifying the healthcare experience by providing an individualized and relevant journey for each member that is streamlined into a series of simple actions. Instead of facing an overwhelming multitude of choices, the health plan member should have a step-by-step guide that includes information and motivational triggers to generate engagement.
Obviously, health plans must embrace the right technologies to facilitate this new approach to member engagement. As an example, the right well-being platform can provide timely information to help members in a myriad of ways, including steering them toward preventive health opportunities such as screenings or matching them to high-quality, high-value healthcare solutions.
Health plans should strive for a one-source, seamless experience that is less confusing for consumers and positions the plan as an active and helpful resource that cares about its members. The right platform can also help a plan be flexible and adapt quickly to changing circumstances, which is more important than ever, as we saw during the height of the COVID-19 pandemic.
PATH 2 | IMPROVE THE HEALTH OF POPULATIONS
Population health identifies and addresses health issues specific to certain communities, demographics and medical cohorts. The goal is to prevent illness before it happens and/or to mitigate its effects. Health plans should work toward identifying, analyzing and finding solutions to these issues by bringing together representatives from many different areas, including healthcare, industry, nonprofit organizations, academia and local government. Again, technology can play a critical role here, as can embracing value-based models for care. Aligning incentives around quality outcomes while equipping providers with data and tools improves the care members receive in-office, virtually and between visits.
On the member side, health plans can leverage technology to provide educational materials, motivation, rewards, reminders, and other interventions that encourage members to participate in scheduled screenings, close gaps in care, or take other necessary actions. The plan can use data analytics and sophisticated models to segment populations by risk factors, likely behaviors, and other characteristics to create targeted messaging. Finally, health plans should invest in technology that supports Social Determinants of Health (SDoH), including the ability to connect members with local resources.
PATH 3 | REDUCE PER CAPITA COSTS AND UTILIZATION RATES
Six in 10 American adults have a chronic disease, and four in 10 have two or more. Using the right technology, a health plan can motivate people to participate in preventive care that reduces the likelihood of developing a chronic condition as well as take part in screenings that can detect diseases at an earlier stage when treatment is more effective. The potential cost savings are enormous.
Even in instances where chronic diseases can’t be avoided, identifying members earlier in their disease process and/or improving the support available for members who are managing chronic conditions can dramatically impact a health plan’s bottom line. Chronic disease can be paralyzing for members and their families, especially when someone is managing multiple conditions. Coming alongside these members to help them take steps that reduce the burden of their disease and decrease unnecessary trips to the ER or hospital makes a big difference in overall costs as well as that member’s quality of life.
SUPPORTING THE TRIPLE AIM WITH TECHNOLOGY
Technology is not a silver bullet, but it is a positive force for fueling the Triple Aim. For our clients, we have seen significant differences between members who are engaged through supportive technologies and those who opt out of such resources. In one example, 81 percent of engaged members closed at least one care gap by taking advantage of digital solutions, compared to only 49 percent of members who opted out of such support. For that same plan, 79 percent of digitally engaged members completed an annual wellness exam compared to 49 percent of members who were not engaged digitally. At the end of the day, technology can change the game for a health plan, but it must be coupled with a smart strategy for engagement and the ability to expertly personalize support based on an individual member’s needs. When these capabilities come together for a plan, powerful results are just around the corner.
Want to learn more about how your health plan can positively contribute to the Triple Aim across your population? Contact us today for a personal consultation.