Health plans set themselves up for success – during a pandemic and beyond – by pursuing advanced technology to engage providers, satisfy members, and improve population health initiatives.

The healthcare system is on the front lines of the novel Coronavirus pandemic, working tirelessly day after day to heal the sick and comfort the anxious. Health plans, in understanding the potential impact to members, are taking unprecedented steps in waiving copays and cost-sharing for testing and treatment. What stands before all of us is both crisis and opportunity. How you respond has the potential to cement your place in history as a visionary.

A recent Best’s Special Report lauded healthcare payers’ steps towards innovation in technology and partnerships, noting that these leaps are often prompted by times of change and urgency. Challenging situations often exacerbate whatever is not working as well as it should be, evolving annoyances into major problems that need to be fixed pronto. If necessity is the mother of invention, we should expect accelerated adoption of technology and other innovations intended to alleviate pain points during this “black swan” event.

In particular, health plans are likely to push payer-provider relationships, member service, and population health initiatives dramatically forward, moves that hold the potential to change the healthcare landscape permanently for the better. Let’s explore those three drivers in depth.

Improve Payer-Provider Collaboration While Moving to Prepay

We’ve written at length on the need for health plans and their network providers to open the lines of communication and work together to improve broken processes. During the pandemic, that engagement becomes even more essential. Many providers are on the front lines combatting the COVID-19 crisis, adjusting to new care delivery models overnight, losing revenue, or some combination of these. How is your health plan delivering updates to your providers on changes to telehealth coverage, adjusted reimbursement for novel Coronavirus testing and treatment, and select prior authorization waivers?

Health plans are understandably holding off on aggressive payment integrity pursuits at this time, instead focusing on issuing payment as fast as possible, recognizing that over-taxed provider teams don’t need another stressor to contend with. But even before this crisis came to be, the transition to value-based care and an overall shift from payers denying payment to more guiding of care were impacting the payer-provider relationship. Immediate solutions to ease burdens on providers are great in the short-term, but payers will have to think long-term about shifting more claims work to prepay to avoid pay and chase activities.

Shifting to prepay has long been a challenge for health plans because payment decisions on claims must be made quickly, often within two weeks. With numerous disparate data streams and systems at play, payers have not been able to be as agile in prepay as they would prefer. But advanced technology facilitates more seamless coordination with providers, which is required for frictionless payment integrity strategies, including prepay, as well as advanced payment models.

Pareo enables users to easily apply post-pay concepts to prepay and access the information they need to make payment decisions in real-time, which supports your most ambitious internalization strategies. And because Pareo offers a Provider portal to facilitate communication between plans, third-party suppliers and providers, Pareo clients can shift more work prepay while avoiding provider abrasion.

Focus on Members

While health plans have put member service upgrades at the top of their investment lists for a while now, the pandemic has fast-tracked a few of the most crucial. Primarily, technology initiatives that make healthcare available from anywhere, both for convenience and safety reasons.

Providers rely on wearables and remote monitoring devices to manage chronic diseases and detect infections earlier – early evidence shows wearables can even be used to monitor Covid symptoms. Changes in acceptable parameters for telehealth reimbursement by CMS combined with patients embracing the interface promise to change that encounter mix long-term. A recent survey illustrates consumers’ changing mindset around telehealth visits, due to the novel Coronavirus. Though only 25% have ever had a remote health visit, 59% said they are more likely to use telehealth services now than in the past, and 36% would switch their physician in order to have access to virtual care.

Health plans are also embracing technology for streamlined and relevant communications with their members, including chatbots and responsive risk-assessment tools. As one leader of a tech-forward health plan puts it, “It’s all of our digital engagement channels that are required to come together in order to help guide our members through this anxious and uncertain time.”

Make Strides in Population Health Management

One shortcoming this pandemic has highlighted is that the drive towards value-based care is warranted. Value-based care contributes to improved rates of preventive care, leading to a healthier population. This is important, because pandemics like the coronavirus have been shown to prey on those who have certain pre-existing conditions at greater rates than those who do not. Yet addressing population health at a national level requires a great level of coordination among all stakeholders to identify, treat, evaluate and quantify investments in population health management.

Interoperability and the ability to process big data take outsize importance, too. During a disease outbreak, early mapping data could help healthcare organizations and government agencies identify areas where there’s a concentration of people with likely symptoms and therefore higher needs. Testing and disease tracing have proved more effective at containment. Even HIPAA recognizes the advantages of sharing health information during a pandemic and announced a temporary, narrow relaxation of enforcement during this time. “Granting HIPAA business associates greater freedom to cooperate and exchange information with public health and oversight agencies can help flatten the curve and potentially save lives.”

Pareo can assist in care management for health plans by identifying populations at risk, engaging patients and optimizing the care pathway:

  • Predictive modeling that analyzes the patient population from millions of data points helps identify risk factors of early disease.
  • Data modeling delivers lists of current patients and non-patients at risk so they can be engaged, leading to earlier diagnosis and treatment.
  • Care pathways are optimized to provide better, more affordable patient care while increasing the efficiency of your provider network.

Many health plans have already piloted initiatives that address social determinants of health and otherwise target vulnerable segments of the membership for early intervention that promises to improve outcomes and lower costs. A global public health issue like the novel coronavirus prioritizes exactly this sort of useful application of big data analytics.

Technology for the Win

Health plans have been increasingly turning to advanced technology as it evolves to better address a number of operational challenges. Platforms like Pareo that bring together disparate systems and stakeholders, allow for secure remote access, and leverage modern analytics and applications of A.I. to harness the power of big data offer payers a competitive advantage during the best of times and less predictable situations alike. By controlling more of your payment integrity continuum, you are in a better position to optimize your medical spend and drive improvements in the industry as a whole.

Health plans have long been bracing for disruption in an outdated industry. And like all innovators, they’re likely realizing that a global pandemic creates an opportunity to improve on processes and technologies quickly. Improving provider-payer engagement, moving more claims work to prepay, and leveraging technology to improve member satisfaction as well as health plan operations all contribute to broader goals like value-based care and interoperability.

NOW'S THE TIME FOR TOTAL PAYMENT INTEGRITY

Talk to ClarisHealth about how Pareo®, a total payment integrity platform, is driving innovation at health plans.