What Do Health Plans Need To Transform UM, CM, and Pop Health?
53 health plan leaders weigh in
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Overview
Is your health plan meeting its care management (CM), utilization management (UM), and population health management (PHM) goals? If not, you’re not alone.
A new independent survey of 53 health plan leaders finds that many are struggling with ineffective tools that prevent them from fully integrating the growing influx of member data—medical, social, behavioral, genetic—into their workflows. As a result, legacy tools are hindering health plans from strategically leveraging data to reduce costs, improve outcomes, and streamline efficiencies.
Our latest report, based on the survey findings, further explores what is really required to drive impactful changes to UM, CM, and PHM programs.
53 Leaders Surveyed
Preview: The State of Utilization Management
One troubling finding: Just one-third of health plan execs say their UM tools are “very effective” at providing all of the data necessary for timely review and approval.
Clearly legacy UM tools are not as effective as health plans need them to be – and there is room for improvement when it comes to identifying health events in time to impact utilization of services and minimize provider abrasion.
Leaders’ Frustrations with Legacy UM Tools:
Why? Fragmentation and Lack of Integration
Legacy UM tools are just not easy to use, and, in general, the UM process lacks efficient automation.
Given the critical role Utilization Management processes fill for health plans, these legacy solutions must be improved with strategic data use, AI, and automation to sustain member engagement, reduce costs, and improve health outcomes.
Preview: The State of Care Management
The Biggest Barriers to Member Engagement
The research suggests that implementing updated technology that provides quicker access to data and insights would significantly enhance CM. Today’s care management technologies, strategies, and workflows are inadequate for members’ quickly evolving and increasingly complex needs.
Care managers need resources and insights that enable them to engage members at the health inflection point rather than 90 days after the fact. And they need the ability to create workflows based on member preferences, digital member assessments, and more.
Execs Agree. A Holistic View of Members on their Care Journey is Very Important
The Year Ahead in Care Management, Utilization Management, and Population Health was the inaugural webinar in Medecision’s new monthly series. The webinar features four expert speakers who share insights from our recent survey of health plan leaders.
Our February webinar, The State of Utilization Management in 2024, covers the top barriers to UM today – and how healthcare leaders can overcome those challenges to optimize UM.
Our March webinar, The Top Care Management Barriers – And How To Tackle Them, covers the current state of care management, including the top barriers and how organizations can break through them.
Our May webinar, Updates from Inside the Beltway: Analyzing Health Policy Activity and Trends in an Election Year, is presented by Maverick Health Policy. Our panel of Washington, D.C.-based experts will dissect the latest developments and forecast what these mean for the future of healthcare.
Medecision invites interested parties to register for our upcoming webinars to discuss learnings from our exclusive research.
