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Over the past four years, healthcare payers have faced immense pressure to adopt new technologies that aim to increase member engagement, improve clinical outcomes, and control costs. But it can be a challenge to make the most of your health plan’s digital solutions and achieve the return on investment (ROI) you planned for at implementation. Wellframe delivers value to health plans by extending the reach of your existing resources and offering in-app suggestions on how to do more with the tools and insights available.

Below are 5 key ways the Wellframe solution can improve ROI for healthcare payers.

1. Improving Chronic Condition Management

Every year, the U.S. spends about $4.5 trillion in health care expenditures. 90% of this goes toward treating members with chronic and mental health conditions. For members living with one or more chronic conditions, staying on top of health and wellness can be a challenge.

Wellframe addresses these issues by providing a robust digital solution. Diabetic members utilizing the Wellframe app have experienced a remarkable 25% reduction in their blood sugar readings, while members with hypertension have seen their blood pressure drop by up to 9%. These impressive statistics underscore the platform’s ability to facilitate effective chronic condition management, leading to better health outcomes and reduced healthcare costs.

For more on this topic, explore our Member Impact Report.

2. Supporting High-Risk Members Throughout Their Journeys

High-risk members require comprehensive, high-touch support to navigate their complex healthcare needs. Wellframe ensures these members are not left behind. The app offers personalized tasks on daily checklists tailored to individual clinical requirements, including medication reminders, biometrics tracking, and educational content. Moreover, members can securely communicate with their care teams via the app, providing a seamless and effective way to manage their health.

Learn more about supporting high-risk members in our Medicaid Maternal Health Resource.

3. Streamlining Staff Workflows and Increasing Capacity

Traditional care management methods often involve time-consuming tasks such as making phone calls, leaving messages, and conducting questionnaires over the phone. Wellframe revolutionizes this process by enabling care managers to reach more members efficiently. Through the app, care managers can send secure messages to multiple members simultaneously, allowing members to respond at their convenience—leading to a 6x increase in member interactions. Digital surveys and assessments can also be sent directly to members’ smartphones, saving time, ensuring greater security compared to traditional phone calls. By leveraging Wellframe’s digital tools, care managers can double their caseload size, and increase successful phone calls by up to 91%.

Read more about streamlining staff workflows in our Staff Efficiency Case Study.

4. Proactively Identifying and Addressing Health Barriers

Members often feel hesitant to discuss sensitive personal information over the phone. Wellframe mitigates this issue by providing a secure messaging feature where members can comfortably share their concerns and ask questions. Additionally, the platform allows care managers to uncover social determinants of health through digital surveys. With real-time notifications when members complete assessments and automated flagging of high-risk members, care managers can prioritize their outreach effectively, addressing health barriers proactively.

Discover effective strategies for identifying and addressing health barriers in our guide.

5. Increasing CMS Star Ratings and Member Satisfaction

Achieving higher CMS Star Ratings is crucial for health plans aiming to enhance their reputation and secure more rebates—and increasing member satisfaction is a major contributor. The Wellframe solution plays a pivotal role in these endeavors by supporting health plans in delivering timely and effective care, reducing preventable readmissions, and improving the patient experience. Members benefit from a single digital health management platform that provides them with the relevant information and support they need, precisely when they need it. The Wellframe member app boasts a 4.7 of 5 star rating on the App Store, demonstrating its use to members. Proactively focusing on member satisfaction can help health plans increase their CMS Star Ratings, ultimately resulting in greater financial incentives.

Explore our Star Ratings Guide to learn more about improving your scores.

Wellframe stands as a transformative force in the realm of health plan management, offering a comprehensive digital solution that addresses the multifaceted needs of members and care teams alike. By improving chronic condition management, supporting high-risk members, streamlining staff workflows, proactively identifying health barriers, and enhancing CMS Star Ratings, Wellframe delivers exceptional value to health plans. Embrace the future of healthcare with Wellframe and witness firsthand the profound impact it can have on your organization’s efficiency and member satisfaction.

Ready to take the next step? Connect with us today to discover how Wellframe can revolutionize your health plan management.

The healthcare industry is experiencing unprecedented change. New technologies in care management are now widely available to help healthcare payers streamline care delivery, improve operational efficiencies, and automate manual processes.

How are industry shifts impacting the requirements of effective training for care management staff?

Sontz-Morrison: There are several factors influencing the demand for more and accessible staff training opportunities in functional areas like care management. The first is, without a doubt, workforce shortages and high turnover rates. The World Health Organization (WHO) predicts a shortage of 10 million health workers by 2030. This ongoing workforce shortage across allied and behavioral health, long-term services, nursing, primary care, and women’s health is placing an immense pressure on clinicians and support staff to “do more with less.” Despite these constraints, maintaining quality care remains paramount.

Second, the regulatory environment in healthcare is constantly changing. Health plans must remain updated on Medicare and Medicaid regulations while also focusing on improving pricing transparency and healthcare access. Though it can put more administrative burden on care teams, staying up-to-date on new guidelines is essential to ensuring compliance and remaining competitive.

Lastly, the consumer demand for personalization is shaping how we need to develop our training. Modern consumers have come to expect personalized experiences in most aspects of their lives—including their healthcare. These expectations are pushing healthcare payers to adopt new technologies that are transformational. Training for any of these technologies, which can require staff behavioral changes and high adoption rates to be effective, must be fool proof.

The integration of new technologies, evolving regulations, and current workforce dynamics significantly impacts the requirements for technology onboarding and training at health plans. Health plan staff must enhance their knowledge and stay current with regulations to streamline their processes without adding extra layers or underutilizing talent. Without proper education, new tools can become cumbersome for users, causing issues like technology underutilization, administrative errors, missed regulatory deadlines, or missed opportunities to improve member outcomes.

What is GuidingCare University, and how can it support health plan staff?

GuidingCare® University (GCU) is a self-service learning and development solution designed to empower customers and end-users by giving them control over their success. GuidingCare® users even receive alerts before new training modules go live to improve visibility. With GCU, staff have access to comprehensive training on GuidingCare content, technology, optimization, and best practices.

GuidingCare University was designed to serve staff working in a variety of roles, including utilization management, nurses, medical directors, appeals and grievance staff, and population health professionals. By targeting all staff that utilize GuidingCare software, GCU ensures comprehensive training and knowledge sharing across teams. This leads to optimized solution usage, breakdown of internal siloes, and streamlined daily operations.

What are some of the benefits to leveraging GuidingCare University training?

• Continuous Learning: New courses are added quarterly and as needed based on product feature enhancements, ensuring that there are no delays due to a lack of instructors or updated information.
• Real-Time Updates: Training modules go live at the same time as product updates, providing insights and best practices whose value can be passed on to members.
• Increased Efficiency: Employees can access and revisit trainings at any time, reducing time spent searching for answers and getting stalled by not knowing who to ask.
• Improved Accessibility: Training modules are broken into “bite-sized” 5-20-minute segments, making them easy to watch and understand even with a busy schedule. This is particularly beneficial for care managers who balance training with patient care.
• Self-Empowerment: On-demand training modules ensure employees never have to feel like they don’t have enough training to perform their roles effectively. Trainings can also be used alongside organizational onboarding to give new users a comprehensive resource.

Which metrics do health plans use to measure the impact of on-demand training from GuidingCare University?

Key performance indicators (KPIs) play a crucial role in evaluating the effectiveness of training tools like GCU. In addition to tracking metrics like messaging and touchpoint volume, health plans can assess training effectiveness in other ways. Increasingly, organizations are using badge programs and certifications to demonstrate employee skills and understanding of a digital solution.

To help healthcare payers understand how their employees are using the modules and absorbing important information, GCU will be incorporating three new tools into the platform:

• Knowledge checks that pop up throughout training videos.
• Pre- and post-training quizzes to gauge understanding and identify areas for improvement.
• Reporting that tracks video engagement, including watch duration, completion rates, and most rewatched content.

Recently, a customer interview revealed that employees found GCU training streamlined their comfort with the GuidingCare solution. New employees also reported the GCU training modules enhanced their overall onboarding process and helped them feel empowered to fulfill their roles successfully.

The Bottom Line

Today’s healthcare environment demands a responsive and adaptive approach to staff training, especially when it comes to using new technologies. Effective training solutions are not just an option for health plans, but a necessity. By providing continuous learning opportunities and real-time updates, GuidingCare University ensures that staff are well-equipped to meet the dynamic demands of the healthcare industry—leading to better performance, improved member outcomes, and more efficient operations.

Read our brochure, “Empowering Health Plans to Advance Care Management with GuidingCare”

Digital care programs have emerged as a transformative tool to improve clinical outcomes and member engagement. From supporting maternity populations to managing chronic conditions like Diabetes, digital care programs can provide personalized support to members across the risk pyramid. However, the success of these programs hinges on meeting members where they are to keep them invested in improving their health.

Unlocking the Potential of Digital Care Programs

Digital care programs offer immense potential to improve clinical outcomes and member engagement. By implementing best practices such as omnichannel support, consistent communication, personalized information, and accessible language, health plans can enhance the member experience and increase care program completion rates.

The Wellframe solution makes it easier for members to take control of their health by providing information and support through a convenient digital app. Here, we’re sharing best practices to drive member engagement for digital care programs.

Omnichannel Support: Meeting Members Where They Are

Today’s healthcare consumers expect convenience. They need to be able to reach out to their health plans and care teams on their own time, using the channels they prefer. For many members, this goes beyond answering sporadic phone calls or waiting on hold.

Making care programs available to members via smartphone makes it easier for them to engage at their convenience. They can also engage in multiple ways, depending on their needs and preferences. Wellframe’s omnichannel support ensures that members can interact with their care programs via smartphone or tablet at any time of day, providing flexibility and accessibility.

Key Features:

• 1:1 HIPAA-Compliant Messaging: Members can send secure in-app communications to their care teams. Participants can also send attachments (like photos) and links to helpful information.
• Digital Assessments & Surveys: Instead of calling members and asking them dozens of questions over the phone, send a digital survey or assessment. Members can answer them discreetly, and care managers are alerted when they’ve been completed.
• On-Demand Educational Content: Clinically reviewed articles are written at or below a 4th-grade reading level. This information helps empower members with information they need when they need it.

By offering multiple ways for members to interact, Wellframe makes it easier for individuals to stay engaged and committed to their health and wellness goals.

Consistent Communication: Building Daily Habits

Consistency is key to forming healthy habits, and Wellframe leverages this by providing members with a personalized daily checklist of health-related tasks. Members can check in with the app daily to check messages from their care managers, track biometric data, complete medication reminders, and take other health actions. This consistent communication helps members integrate care activities into their daily routines, making it more manageable and sustainable.

Key Features:

• Personalized Checklists: Tailored tasks and recommended articles based on care program enrollment, medications, and health goals.
• Medication & Appointment Reminders: Keep members on track with the option to create in-app prompts for medications and doctors’ appointments.
• Biometrics Tracking: Encourage members to log biometrics such as weight, blood glucose, blood pressure, and step counts regularly to foster a sense of accomplishment.

By maintaining a steady flow of communication, Wellframe keeps members engaged and motivated to complete their care programs.

Personalized, Relevant Information: Enhancing Member Experience

One size does not fit all in healthcare. Wellframe ensures that each member receives personalized and relevant information tailored to their specific needs and health conditions. This personalization enhances the member experience by making educational content more applicable and engaging.

Key Features:

• Digital Care Programs: Clinicians enroll members in digital care programs based on diagnosis, condition, or health goals. Currently, Wellframe offers more than 70 care programs.
• Targeted Content: Members receive links to suggested articles on their daily checklists. Articles are related to the member’s current care program.

Providing personalized articles and information keeps members engaged and helps them feel understood and supported.

Steer Clear of Healthcare Jargon: Bridging the Health Literacy Gap

With only 12 percent of Americans having proficient health literacy skills, it is crucial to use accessible language in digital care programs. All Wellframe content is written at or below a 4th-grade reading level to ensure it is accessible to as many members as possible. But accessible language should go beyond educational health content—nearly 1 in 4 members said they are “often” or “always” confused by health plan communications.

Key Features:

• Simplified Language: Avoid healthcare industry jargon and use clear, straightforward vocabulary. Member communications should be written at or below a 4th grade reading level.
• Educational Resources: Healthcare information should be easy to understand and act upon.

By simplifying the language used in member-facing communications and articles, Wellframe makes healthcare more approachable and reduces barriers to engagement.

Leveraging Wellframe Solutions: A Comprehensive Approach

Wellframe offers robust solutions designed to enhance member engagement and improve clinical outcomes. Wellframe’s Digital Care Management and Clinical Advocacy services provide comprehensive support across the healthcare continuum.

Key Solutions:

• Digital Care Management: Streamlining care processes and improving member experience.
• Clinical Advocacy: Offering personalized support and guidance to members.

By leveraging Wellframe’s solutions, health plans can create a more connected, efficient, and effective care ecosystem.

The healthcare landscape is fiercely competitive, with both established payers and innovative disruptors vying to capture market share. Yet, in this rush, a crucial factor often gets overlooked: member engagement.

In our five-part blog series, HealthEdge Source™ Horizons, we demonstrate how our payment integrity solution empowers health plans to achieve compliance, expand market reach, and manage value-based care. In this blog, we will dive into how health plans can enhance payment accuracy and transparency, the cornerstones of member trust and engagement.

Read the entire series at the links below:

• Ensure Regulatory Compliance and Cost Transparency
• Improve Payment Accuracy and Efficiency with Advanced Automation
• How Payment Integrity Innovation Helps Expand New Business Opportunities
• Simplifying Value-Based Care Contracts & Reimbursements
• Increase Member Engagement & Build Trust with Cost Transparency

Why member engagement matters

Member engagement goes beyond profit; it directly impacts health outcomes. Engaged members take a more active role in their healthcare, leading to better health outcomes and lower long-term costs for your plan.  However, factors such as inaccurate payments, lack of transparency, and delays can erode trust and disengage members.

Our recent webinar, “Empowering Modern Health Care Consumers,” highlights the importance of member satisfaction. We emphasize the critical role of payment accuracy and transparency in building member engagement. By offering clear explanations of benefits, coverage details, and out-of-pocket expenses, you enable members to make well-informed healthcare decisions. This not only reduces anxiety about surprise bills but also fosters collaboration, leading to a stronger partnership and better health outcomes.

Increase health plan efficiency to improve member relationships and engagement

Reduce clinician burnout from administrative overload

Clinicians are drowning in administrative tasks, leading to burnout and less time spent with patients. Every minute spent on paperwork steals valuable time from direct patient care, hindering the ability to deliver personalized and attentive care.

HealthEdge Source alleviates this burden for clinicians, creating a ripple effect of positive outcomes. Our solution automates essential claims and payment processes, freeing up time for clinical decision-making. By streamlining routine tasks and simplifying complex processes, we eliminate the need for time-consuming manual reviews. This allows clinicians to refocus their energy on what matters most—delivering high-quality patient care.

With more time dedicated to patients, improved communication and a more positive patient experience naturally follow. And reduced clinician burnout leads to lower turnover rates, saving on costly recruitment and training expenses.

Offer pricing transparency and easy access to information for members

Transparency in healthcare costs and coverage is a top priority for both your members and regulatory agencies including the Centers for Medicare and Medicaid Services. Empowering your members with clear, accurate information is key to building trust and driving engagement.

Here’s how we help health plans achieve transparency:

• Eliminate Surprise Billing: Our cloud-based system ensures accurate estimates upfront, preventing surprise bills and fostering trust from the beginning.
• Real-Time Information Access: With 24/7 data access, your plan or any providers can proactively communicate coverage details and potential cost-saving options directly to members.

Cloud-based data delivery ensures that your plan has the most up-to-date and accurate content and regulatory updates, eliminating confusion and errors. Furthermore, cloud-based processing reduces wait times by streamlining claims and inquiries. Most importantly, the cloud provides a secure and scalable environment to protect member data and ensure smooth system performance even during peak demand.

Happy providers = Happy members

Building strong provider relationships is crucial for a health plan’s success. Happy providers lead to happy members, yielding better health outcomes and reducing long-term costs. Designed for true Payment Accountability, HealthEdge Source not only streamlines internal operations but also allows you to nurture these crucial relationships.

Traditional claim processing frustrates providers with errors and inconsistencies. Our Platform Access technology solves this issue by streamlining internal operations, ensuring accuracy, transparency, and comprehensive claims payments upstream in the adjudication process. Now you can transform your business, organize your data in a single place, address root cause issues, and pay claims right the first time.

With key features including:

• Editing Library with History: Access historical data, parameters, and exceptions for edits, allowing for informed decision-making.
• Custom Edit Builder: Tailor specific edits to meet your unique payment arrangements and cost-saving goals.
• Real-Time Analytics: Gain valuable insights into performance metrics and the impact of edits on your claims process.
• Monitor Mode: Test the impact of edits on your system before implementation, minimizing disruptions.
• Comprehensive Audit Trail: Track and view claim-level edit details for complete transparency.

Our platform seamlessly integrates with your existing systems, eliminating the need for disruptive rip-and-replace solutions. Regular updates ensure your system stays current, while the scalable design allows you to adapt to future needs.

By providing a single, streamlined platform for accurate and efficient claims processing, we can help you to build stronger relationships with your providers. This translates to a win-win for everyone: happier providers delivering better care, a more satisfied member base, and a healthier bottom line for your health plan.

Ready to learn more?

Explore our blog series, “HealthEdge Source™ Horizons,” to discover how our solution can help you achieve compliance, expand market reach, and manage value-based care.

Want to learn more about how your health plan can access valuable analytics while increasing payment accuracy and transparency? Read our blog, “The Shift to Payment Accountability®: An Enterprise Approach to Healthcare Payment Integrity.”