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Alleviating Payer Pain Points and Improving Member Care With Telehealth

By Glenn Nichols

As the delivery of care evolves from traditional settings like from the hospital into the home, tools such as telehealth and remote monitoring help payers capture a longitudinal view of the member outside the acute setting.  

This blog discusses how telehealth and remote monitoring helps payers resolve key challenges and create new solutions to improve member care and address rising healthcare costs. 


Retain and Attract Members

Members want choice, convenience and access to affordable healthcare from providers who are caring and empathetic. Payers who embrace member care preferences and create comprehensive, member-friendly programs stand to attract more members and grow market share.

Download the eGuide: 6 Reasons Why Telehealth Makes Sense for Payers

Bundling telehealth and remote monitoring as a supplemental benefit is a key competitive feature for Medicare Advantage (MA) plans. A recent report shows that more than 94% of MA plans expect to offer expanded coverage for virtual member care initiatives during 2021 open enrollment.  A bundled remote monitoring supplemental offer allows plans to appeal to existing members as well as new eligible beneficiaries seeking innovative and engaging options to better their care. 

High-touch, member-centric care builds trust and loyalty, which, in turn, increases member retention. Telehealth tools allow providers to expand outreach and establish lasting connections. Members who sense a strong partnership with their provider are more likely to engage in their care plan, and experience greater overall satisfaction. A positive member care experience translates into greater satisfaction and higher CMS star ratings.

Addressing SDOH to Achieve Health Equity and Control Costs 

Social Determinants of Health (SDOH), such as education, literacy, housing and economic stability play a growing role in influencing health outcomes. To better manage rising costs, payers are developing innovative, holistic, population health programs that address both the socioeconomic and unique clinical needs of their members. 

Many beneficiaries are susceptible to a broad range of non-clinical social and economic factors such as hunger or lack of access to healthcare services and transportation. These factors leave members at an elevated risk for missed appointments, health set-backs and hospital readmission. With on-demand virtual care, members gain expanded access to resources and can visit providers through virtual appointments without the need for travel and wait times.

Unlike a typical exchange during an office visit, Telehealth and virtual care afford providers a unique window into how members live, the obstacles they face and other factors that influence their health. Data captured via remote monitoring and insights gained during care team exchanges help payers and providers identify cost drivers, prioritize strategies and create programs that address their members’ social needs.

Adopting strategies that incorporate tools to address the SDOH, allows plans to positively influence health equity, better manage costs and improve member outcomes.

video visit with provider

Scaling Risk Stratification and Personalization of Care

Telehealth and remote monitoring provide tools to personalize and scale delivery of care based on stratified populations. Providers identify members who are at-risk for adverse events such as ED visits, hospital admissions or readmissions. Creating proactive member care plans, based on comprehensive member records, biometric data and insights derived from predictive analytics help providers assure that the right member receives the right care, at the right time. 

With telehealth, payers utilize a data-driven platform to manage workflow and improve resource efficiency. Virtual access and automation allow the care team to reach more patients and boost performance, all while reducing costs and improving the member care experience. 

Remote monitoring and telehealth can provide great value as organizations seek to better align Medical Loss Ratio (MLR), specifically their administrative spend against the percentage of premium invested back into their membership. Administrative costs designated by MLR include activities that improve patient outcomes, prevent hospital readmissions, or promote wellness. These quality-driven objectives are also leading benchmarks of an impactful telehealth program. 

Low Member Engagement Hurts the Bottom Line 

Improving member engagement helps reduce member churn, support retention, create happier members and enforce higher quality scores.  

Payers use member activation metrics to measure care management program ROI. Member activation rates are a strong indicator of program success and help providers evaluate the impact of learning objectives and message retention.  

Telehealth and remote monitoring tools allow providers to engage members at home where they’re most receptive to care management. Providers encourage active engagement through video, voice and text messaging, and tools such as symptom surveys, medication reminders, and condition-specific education.    

Care teams can also tap into the important role that caregivers play in influencing member success. With telehealth, caregivers can participate in group-calls with providers and monitor their loved one’s adherence to the care plan. 

Telehealth helps improve member activation by providing members with tools to actively engage in their own health. When telehealth is leveraged correctly, behavior change is the result. Behavior change results in a more engaged patient resulting in improved outcomes, better health, and reduced cost of care.

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Tags: Patient Engagement, cost savings, Payer, ROI, Access to care

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