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The Future of Managed Care is Personal

August 07, 2019

Social determinants of health data can help sponsors identify members for outreach campaigns focused on their personal risk factors.

In a healthcare system known for its complexity, Ubiquity is helping managed care partners engage members, drive retention and reduce costs by getting personal.

With Medicare and Medicaid spending expected to surge higher over the next decade than in the previous 10 years, the Centers for Medicare & Medicaid Services (CMS) is trying to combat rising costs by helping members improve their health. As part of that effort, in 2018, CMS gave Medicare Advantage plans the green light to significantly expand member benefits by revising the definition of supplemental member benefits to include anything that has “a reasonable expectation of improving or maintaining the health or overall function.”

Adding new benefits alone is not enough. Plan sponsors must ensure that their members know about their benefits and are taking full advantage of them. Member engagement is a key part of Ubiquity’s fast-growing healthcare business line. We sat down with Ubiquity’s Vice President of Healthcare and Government Solutions Carlos Baltodano to find out what trends are shaping the healthcare market and how Ubiquity is helping partners gain a competitive edge.

Q: What is the biggest concern for Ubiquity’s healthcare partners?

A. Being left behind. For the most part, innovation in the private healthcare market has surpassed what we’ve seen in government-sponsored healthcare. Sponsors are looking for competitive advantages around preventative care and utilization coordination.

Right now, there’s a high degree of focus within managed care on social determinants of health (SDOH)—member level data points like income, neighborhood, loneliness, education, job readiness, transportation and access to healthy food options—as they can be significant indicators of health. Adopting an SDOH strategy enables sponsors to engage their members based upon these risk factors, which traditionally have not been captured in medical diagnosis codes. SDOH goes far beyond simply identifying those members with conditions like diabetes or heart disease as being more likely to be high utilizers of care. In fact, SDOH data can help sponsors identify high risk members well before a diagnosis.

Within managed care, Ubiquity’s partner WellCare Health Plans has been at the forefront of addressing SDOH risk factors with market-specific campaigns such as providing access to career training and resume services. Across the managed care space, it has become an industry expectation, as opposed to a luxury, for sponsors to deliver and promote non-medical benefits that directly address SDOH risk factors with a goal of improving member health and decreasing the likelihood of future high-cost care.

Q. Where do you start with an SDOH strategy? 

A. It’s really all about data analytics and being able to first identify member populations at higher risk of things like unemployment, loneliness, or those who are more likely to skip medications or physical therapy. Once identified, member engagement campaigns should be tailored to address the personal risk of each member. For some members, you might focus on unemployment and helping members coordinate subsidies through state and federal agencies and community groups. For others, it might be helping them sign up for meal delivery.

Q. What are some best practices when it comes to this type of outreach?

A. We assign a static list of members to each Ubiquity care navigator. Based on our internal data and results, matching members to dedicated care navigators increases the success rates of each engagement by as much as 60 percent.

Ubiquity care navigators average more than one engagement per quarter with each member they are assigned compared with the industry average of one contact per year. Where it traditionally might take several quarters or years for a member who has become under or unemployed to enroll in unemployment, for example, Ubiquity can identify and engage those members much more quickly.

Care navigators also answer member calls, but our partners strategically are increasing the volume of outbound calls to help members schedule rides for upcoming doctor visits or assist them in claiming their gift card reward for completing their quarterly screening on time.

Another thing to keep in mind is that outreach campaigns are most effective when you’ve got the full view of member data and their history of engagement, so partnering with a firm that is providing member-level data for inbound and outbound communications is ideal.

Q. Where are investments being made in healthcare right now?

A. There is a growing trend in investments geared toward improving the member and patient experience. The healthcare market will continue to see significant regulatory and market-driven pressure to address SDOH factors, improve coordination of post-acute care and to prioritize their member and patient Net Promoter scores. At the end of the day, we always want to focus our efforts on what is in the best interest of members and patients. In Ubiquity’s experience, SDOH initiatives yield the greatest benefit by preventing the development or advancement of conditions that would require chronic or acute care.

With the proliferation of pay-for-performance arrangements and emphasis on quality measures, managed care is a rich environment for venture capital and innovative organizations. In my opinion, no other U.S. market sector has the low barriers to entry combined with strong market demand for new ideas and innovations as managed care.

Q. Where is Ubiquity investing?

A. We’ve invested heavily in data analytics—how we capture the data and how we maximize its usefulness to our partners. An important aspect of that is being able to pull data from multiple lines of a partner’s business to augment Ubiquity sourced data. That translates to significantly greater accuracy of Risk Adjustment Factor (RAF) scores, higher quality ratings, and lower volumes of grievances and appeals. By generating a complete picture of each member’s data profile, we’re able to design our member support and outreach efforts to maximize results. Through Ubiquity’s investments, our team can function as the primary driver of quality improvement and member engagement campaigns at the enterprise level for our clients, as opposed to separate initiatives being executed by each client department.

The future of healthcare is personal. It’s all about improving the member, patient and provider experience. When we think about new technologies within managed care such as artificial intelligence—in which Ubiquity also continues to invest heavily—we see opportunities for increasing the scope and quality of human-to-human interactions. AI in healthcare is often focused on diagnosis and patient care, but we will use AI to enhance care navigator performance and ensure that members have the best (and most compliant) experiences imaginable.

Contact us to learn more about Ubiquity’s approach to helping health plan sponsors engage their members to improve satisfaction and loyalty to drive retention.