HealthMay 03, 2024

How can care management programs broaden their outreach to members?

Virtual-first programs and digital patient education offer creative platforms for care management teams to overcome complex communication channels and extend their reach to isolated or busy members.

Care management: Understanding the need for expansion

Within a changing healthcare environment, payers are seeking innovative ways to improve their scores and member satisfaction. This changing environment includes:

Disparities in healthcare

Despite advancements, significant disparities in access to healthcare persist across different regions.

Changing demographics

Aging populations, more isolated populations, and an increased prevalence of chronic diseases necessitate a shift in engagement tactics.

Technological evolution

Digital health technologies are maturing and expanding remote care management and monitoring.

Health Equity Index

The Centers for Medicare & Medicaid Services’ (CMS) Health Equity Index is requiring health plans to work toward increasing all forms of accessibility to healthcare services and coverage.

Within payers, care managers – who represent a key opportunity for person-to-person connection with plan members – excel in this environment. However, as care management is typically a small team, their leadership is tasked with understanding how to scale efforts to deliver personalized experiences across broad member groups.

Care management leaders need to look for ways to expand their reach to connect with more members in diverse communities to ensure they have access to convenient, quality, equitable care. Not only do satisfaction scores depend on this, but actual member outcomes and loyalty are closely tied to how well each plan does this.

Nonetheless, the drive to reach more members is a long-held goal of most care management teams. Finding success in today, and tomorrow’s, healthcare landscape will require new approaches.

Telemedicine supporting a diverse and dispersed member base

Over the pandemic, telemedicine became much more popular, and with that growth, it opened an avenue for care management programs to extend their reach to more members and underserved segments of the population.

In particular, telehealth services can be effective ways to reach rural populations. From 2010-2021, nearly 140 rural hospitals in the U.S. closed, creating a care access challenge for many living in those regions. If care management can work to suggest alternate care, including virtual options, that could save time, expense, and offer a more convenient method for reaching members in rural areas with vital health and wellness interventions. It would also go a long way for member satisfaction.

However, telehealth wasn’t the only change brought on by the pandemic.

Remote work has become far more common in the U.S. As of 2023:

  • 12.7% of full-time employees in the U.S. work from home.
  • 28.2% work a hybrid model.
  • 32.6 million Americans are expected to work remotely by 2025.

This can present a new and interesting challenge for care managers, who are now seeing plan members from a wide geographical area as the employer groups they serve hire from farther afield with a talent pool not constrained by office locations.

Further, with their work already largely digital, remote workers have an expectation that at least some of their healthcare encounters should occur virtually as well. Members now have an expectation of convenience, and they want to keep the choice of going back to in-person visits or staying virtual, when appropriate.

The impact of virtual-first programs

Payers have come to realize they can be the glue between telemedicine and physical care and have created virtual-first solutions to build on that. Virtual-first solutions offer 24/7 access to virtual care benefits, including telehealth provider visits and educational tools powered by conversational AI.

Payers creating these plans provide access to telehealth providers and specialists for plan members with exclusive virtual access, as well as a virtual health coach to help facilitate appointments, interactions, and answer questions.

In the end, these plans are not 100% virtual, but they do incentivize members to do a number of things virtually before they go to physical care.

These plans have proven to be popular with both members and employers. With employees no longer having to take hours out of a busy workday for some doctor’s appointments, these programs save employees and their employers a tremendous amount of time and stress.

For care managers, virtual-first programs can help with coordinating case management. Virtual follow-up appointments are easier to schedule, and members are more likely to adhere to care plans as they decrease barriers to access. They can also prevent health issues from escalating because members have easier communication channels to ask questions or raise issues after health events, hospitalizations, or provider visits. Without this option, members who have concerns – such as new symptoms, medication questions, or changes to their routine that don’t seem emergent – may wait weeks or months until their next primary care or specialist appointment. Care managers can use virtual programs to bridge those gaps and connect members to faster answers, education, and ultimately, satisfaction with their care.

Digital health education supports virtual and
in-person encounters

Virtual care support is not the only avenue for greater engagement that can impact a broad range of members. Care management teams can help plans boost their satisfaction scores by helping members maximize the limited time they have with providers, time that may change as virtual-first plans become more commonplace. Augmenting health education with digital tools is a strong place to look for opportunities.

Care managers can engage with members pre- and post-visits to begin this process. They can answer questions ahead of an upcoming appointment to help members prepare for an appointment and understand what materials or information they might need to bring. This can be especially important for members in rural settings who may have to travel more than 50 miles for an in-person appointment.

After the visit, there are additional opportunities, according to a 2022 survey:

  • Nearly half of the respondents said they did not get all their questions answered during their provider encounter.
  • 80% often or sometimes had follow-up questions.
  • 80% said that if they were to receive patient education, they would be more satisfied with their care.

Digital member education offers care managers a way to follow up with members conveniently and in an accessible, personalized way that can help relieve provider burden of phone calls and subsequent appointments.

With digital leaflets and videos, members can learn at their own pace and on their time. Materials can also be targeted to higher-risk members to ensure key information about conditions and wellness is reaching those who are most isolated from care or those exhibiting other risk factors.

Member engagement materials with a focus on diversity, equity, and inclusion also help care managers reach a broader group and make care more accessible for all members and patients. That means sharing member-facing content that:

  • Speaks the language the members use at home.
  • Varies the visual representation of patients and clinicians.
  • Employs voice-over artists from different cultures to reflect different experiences.
  • Uses gender-neutral terminology and images.
  • Accounts for wide variety of socio-economic realities in content.
  • Offers greater technical accessibility.

More inclusive content helps to better resonate with members, increases engagement, and assists health plans in meeting the benchmarks related to the CMS Health Equity Index.

Spreading the word about care management resources

Perhaps one of care management’s greatest challenges to expanding outreach is getting the word out about their own programs and value.

Unfortunately, much of care management is outbound calling and trying to engage members in an era when fewer and fewer people answer their phones. Everyone is inundated with emails and texts. How can health plans make members aware of the available services?

The answer may lie in personalized, targeted outreach that ties into existing interactions. If a member is seeking information about their condition or coverage with their payer, that is when care management can refer members to targeted resources and programs that the members may not be aware of. Teams need to get creative about how to weave their outreach into existing communications to help people when they’re most likely to take action — e.g., a new diagnosis, a life event for the family, a change in employer or health plan. That’s what makes it even more important to have systems that are talking to each other to help overcome some of those barriers.

Whitepaper: Opportunities for care management to expand healthcare education

With rising member expectations and needs, payers and care management teams that want to broaden their reach and impact must step up their education efforts and become more equal partners in health. 

Learn more in the whitepaper “Filling the healthcare education gap: A care management opportunity.”

Download the whitepaper by filling out the form below.
Mitch Collier headshot
Technology Product Management Associate Director, Wolters Kluwer Health
Mitch Collier is an experienced software development leader with a demonstrated history of delivering successful solutions in the healthcare industry. Mitch focuses on improving member and patient engagement, optimizing workflows, and leveraging data to better manage population health. With nearly 25 years of experience in digital health, Mitch has specialized in virtual care solutions for health plans, health systems, and large employers.
UpToDate Digital Architect
Harness the trusted expertise of UpToDate clinical content and give your organization access to the building blocks to deliver unique digital experiences for your patients.
Back To Top