Driving Patient/Member Engagement for Value-Based Performance: Why Leveraging Technology is More Important Than Ever

Revenues from value-based care contracts are increasing. The latest data reveals that 14% of U.S. provider reimbursements are tied to capitulated risk models, up from just 7% three years ago. At the same time, changes in federal policy – ​​particularly regarding Medicaid eligibility and plan continuity – add new urgency to efforts to keep patients actively engaged in their care.

As the financial stakes rise, many healthcare organizations face challenges in enabling scalable and consistent patient engagement across large and diverse patient populations. One of the biggest barriers to value-based performance occurs when healthcare organizations struggle to help patients take the right steps to improve their health. This is especially true when a provider organization must determine how to connect with members who have never had an encounter but are assigned to the physician panel through a managed health care plan.

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

The Power of Data-Driven Engagement

Even as healthcare leaders recognize renewed momentum toward value-based care, a 2024 Advisory Council survey suggests that provider readiness remains a key issue when it comes to resources, capital and consistent leadership alignment.

Technology remains essential to preparedness, and the use of data and analytics – including support from artificial intelligence – will continue to be an important factor in the success of risk-taking sustainable strategies. That’s why leading providers and health plans are turning to population health platforms that integrate with EHRs and offer advanced features to drive awareness.

For example, when a patient has not had a wellness visit in more than a year, this triggers an alert in the population health management platform. The patient automatically receives an orchestrated sequence of secure text messages, prompting them to schedule an appointment, whether by phone or via a scheduling link.

Additionally, this type of automated outreach ensures that patients do not miss important deadlines for Medicaid redetermination and health plan re-enrollment. With evolving federal guidelines placing greater responsibility on patients to maintain their coverage, having automated, near real-time outreach capabilities is no longer a necessity: it is essential to keeping individuals connected to care.

In cases where a health plan member is assigned but has not established care with a provider, personalized text reminds the member of their health plan benefits and offers to help them schedule a visit. Once the 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 start again.

This type of “set it and forget it” solution ensures that staff do not need to manually move data between tools or call patients to engage them. It also leverages a tool that most American adults already own: a cell phone. Pew Research data indicates that 98% of adults own a cell phone, and 91% own a smartphone.

Better outcomes through scheduling patient visits

As healthcare embraces value-based care, targeted, data-driven outreach helps address gaps in care that impact performance. Along with this more proactive engagement, providers should also leverage technology that supports patient visit scheduling to ensure that time spent with patients is comprehensive and optimized.

Care team members, armed with daily patient and appointment information, can come together in the morning to identify, plan and prioritize what needs to be addressed with each patient. Alerts ensure providers don’t miss scheduled vaccinations or screenings, preventive services such as cancer screenings or A1c tests, and key deadlines to ensure continuity of care such as Medicaid redetermination and health plan re-enrollment. The right solution can also identify patient risk factors, such as smoking, obesity, mental health and social challenges, that could influence care and treatment decisions.

Proactive scheduling of patient visits allows busy 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, a Midwest integrated outpatient and inpatient hospital using tools to support pre-visit planning closed nearly three times as many diabetes A1c and depression screening gaps as without the daily guidance.

Technology and collaboration for better VBC results

As risky contracts reach higher percentages of overall revenue potential, providers and health plans must collaborate to achieve and maintain a healthy bottom line. Targeted outreach and more proactive visit planning to optimize provider-patient time will be important factors in laying the foundation for success. Health plans and providers that take a collaborative, technology-driven approach are able to achieve better results in clinical quality measurement, risk adjustment factor recovery rates, and cost savings, while producing better health outcomes – a win-win for everyone involved.

Source: metamorworks, Getty Images

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