5 Healthcare Trends Transforming Care Management Software

The healthcare industry, care management practices, and software that enables health plans to provide exceptional service to members are all undergoing significant changes. Market dynamics, disruptive technologies, innovations in data availability, regulatory pressures, and changing member expectations create new challenges for health plans. But they also promise a more efficient and member-centric healthcare system in the years ahead.  

Health plans’ adaptability and the technology that enables their transformations will remain at the forefront of strategic decision making in 2024 and beyond. Let’s explore the key trends that affect care management and raise the bar for software capabilities today. 

Trend 1: Rising Member Expectations 

According to the 2024 HealthEdge® Consumer Survey, member expectations are evolving rapidly. The survey findings indicate an increasing need for member experiences that are tailored to individual preferences, easy to access, and provide clear information about healthcare costs and coverage. Members’ expectations are increasing due, in part, to highly personalized retail experiences with commercial organizations. 

Health plans need to adapt to these changing expectations to stay competitive. Just as retail companies use algorithms to analyze behavior and provide personalized recommendations, health plans can utilize data to offer personalized care recommendations, wellness programs, and effective communication to improve members’ experiences. 

In contrast to many online retail experiences, human interaction is essential for success in healthcare. The 2024 HealthEdge Consumer Survey also shows higher satisfaction levels among those assigned a dedicated care manager, for example, but also a growing demand for high-touch care management. This highlights the importance of care managers’ access to member healthcare data, particularly social determinants of health data, to enhance personalized care. It is crucial for health plans to make people available to deliver customer service and, at the same time, to expand the self-service tools and resources that make interactions more efficient. 

Member expectations are also at the heart of numerous regulatory changes focusing on cost transparency and interoperability. From the Transparency in Coverage Act to the No Surprises Act, the Centers for Medicare & Medicaid Services (CMS) has stressed the significance of electronic data collection, retention, and utilization to enhance member experiences, improve health outcomes, and reduce inefficiencies in the long term. The pace of change is accelerating, pushing health plans to look further into the future, be more agile to meet member expectations, and update their requirements for a care management platform.  

Trend 2: Digital Member Engagement 

According to the 2024 HealthEdge Consumer Survey, there is a significant shift toward members looking for personalized healthcare experiences: 64% of respondents expressed comfort in using secure mobile apps to interact with their health plans. This trend is notably consistent across various age groups, underscoring the broad acceptance of digital tools for healthcare management. Today, omnichannel communications unify the member experience across websites, mobile apps, phone calls, and in-person visits, enabling seamless transitions and greater member engagement. This plays a critical role in enhancing member care management in two primary ways: 

• By integrating multiple channels, including mobile apps, care managers can customize interactions to individual member preferences, engage members more effectively, and focus on meaningful interventions for positive health outcomes. 

• Through streamlining processes and interactions via digital channels, health plans reduce member wait times for prescription refills, referrals, test results, etc., and empower staff to be more responsive through preferred contact methods. 

Adopting an omnichannel strategy, supported by modern care management software, empowers healthcare teams to provide personalized, efficient, and member-centric care—enhancing member satisfaction and improving outcomes. 

Trend 3: Increased Market Competition 

Historically, health plan members had limited options for coverage, and were often content to accept the narrow choices of employer-provided benefits, while seniors faced relatively straightforward decisions about Medicare. However, today’s landscape is vastly different, leading to increased competition between health plans: 

• Members now have a wide array of options. Seniors can choose from nearly 4,000 Medicare Advantage plans, offering an average of 43 options in their coverage areas. 

• CMS continues to emphasize the high weight of member satisfaction scores for the 2024 rating year, reinforcing that exceptional member experiences must be a top priority for health plans.  

• Participation in the Affordable Care Act’s health exchange marketplace, individual plans, and Medicaid has surged, leading to many new members comparing suitable health plan offerings. 

• Healthcare and government agencies focus on whole-person care that improves health outcomes and includes specialty areas such as behavioral health. Employers and health plans collaborate to create inclusive benefit plans, while integrating digital tools and virtual care options enable nontraditional care for various conditions. 

Health plans must prioritize personalized member experiences, innovative digital solutions, and cost transparency to attract members due to advancements in whole-person care, new regulations, and higher member expectations. This requires a care management platform that merges data, enables seamless care coordination, and allows effective communication with members on their terms.  

Trend 4: Social Determinants of Health and Person-Centered Care 

The Framework for Health Equity, from CMS, serves as a foundational roadmap to advance health equity, expand coverage, and improve health outcomes for over 170 million individuals. The framework addresses the following in pursuit of its mission:  

• CMS aims to enhance the gathering of individual-level demographic and social determinants of health data, including race, ethnicity, language, gender identity, sex, sexual orientation, and disability status, to ensure fair care and coverage for all.  

• CMS is dedicated to evaluating its programs and policies for unintended consequences and measuring their impact on health equity to develop sustainable solutions for closing healthcare access, quality, and outcomes gaps. 

• CMS supports healthcare organizations in reducing health and access disparities by empowering providers and organizations to address the root causes at the point of care. 

• The framework integrates health equity into existing and new efforts, driving structural change, eliminating barriers, and enhancing health outcomes through data-driven insights and personalized strategies. 

The focus on social determinants of health, person-centered care, and healthcare equity has increased. Modern care management systems play a key role in complying with these regulations, leveraging shared data, and coordinating care in an increasingly complex array of healthcare services. 

Trend 5: Artificial Intelligence (AI) in Healthcare 

The healthcare industry is investing in developing AI capabilities to streamline processes and improve the member experience, especially with the development of generative AI capabilities. Compared to other industries, healthcare has been slower in adopting these advancements, presenting a significant opportunity for improvement. Recent research suggests that increased use of AI could result in a 5-10% reduction in US healthcare spending, including member services.  

AI in member engagement shows promise in empowering care managers, assisting members with routine inquiries, and optimizing the care journey. Moreover, the increasing comfort with AI-powered tools reflects a growing demand for personalized and efficient healthcare experiences. About 65% of members prefer health plans that leverage AI for personalization. This technological shift enhances the member experience and enables health plans to provide more tailored and proactive care. For instance, natural language processing could be used in a chat-based interface to allow health plans to provide quick, accurate benefit details to members during live calls. This capability, combining robust data with AI-powered interfaces, will soon become a reality, streamlining benefit inquiries, improving service, and enhancing customer satisfaction.  

The march towards AI-powered healthcare is underway, and health plans must focus on the most impactful use cases, the right technology partnerships, how AI affects their roadmaps, and the governance required to use AI for its best purposes.  

Adapt to Modern Care Management with HealthEdge 

The HealthEdge® GuidingCare® care management software streamlines coordination across the care spectrum, automates care and service planning, and identifies high-risk populations to better enable whole-person, member-centric care. It centralizes health data to enhance care and uses advanced analytics to predict health issues for proactive intervention. The demands and opportunities of care management today lead to more health plans redefining their software requirements and seeking end-to-end solutions to grow membership and improve the care experience. 

To learn more about how GuidingCare can help accelerate your care management transformation, visit our infographic: “Secrets of a Successful Care Management Implementation.”