Increase Care Management Capacity And Efficiency With Digital Care Management

In an era where healthcare demands are rising exponentially, and health plans are stretching their budgets, increasing the capacity and efficiency of care management is becoming a key area of focus. As care management models evolve, care teams are increasingly asked to do more with less—and are facing a growing cognitive burden while doing so. Wellframe’s digital care management solution empowers care teams to extend their reach and serve broader member populations using real-time insights.

Empowering Care Teams with Digital Solutions

Care teams today face unprecedented pressures from multiple angles. They are tasked with managing complex patient needs while grappling with administrative responsibilities and high workload volumes. Wellframe’s digital care management solution offers a lifeline by delivering real-time member insights and enabling care teams to reach multiple members at once.

Using the Wellframe platform, health plans can reach and engage rising-risk members before they become high-risk.

Member Empowerment

Empowering members to take control of their own health and wellness is at the heart of Wellframe’s approach. With over 70 care programs that enhance traditional care management models, members are equipped to manage their health proactively.

The platform offers a self-service resource center that features clinically reviewed articles relevant to members’ health and wellness needs. They also have access to benefits information written in plain language to help improve understanding and utilization. These tools promote self-advocacy and health literacy for health plan members, enabling them to become more independent and confident in navigating the healthcare system.

Workflow Efficiency

The Wellframe solution helps significantly reduce the cognitive load on care teams through several features that streamline their workflows while enabling them to increase care management capacity.

1. Dynamic Decision Support:

Intelligent alerts and insights recommend high-impact interventions, helping care teams prioritize and act swiftly on critical issues.

2. AI Summarizing Capabilities:

Streamlined summaries facilitate quick, informed decision-making, allowing care managers to focus on member-centered care rather than administrative tasks.

3. Digital Assessments:

Digital surveys and assessments remove the administrative burden associated with telephonic health risk evaluations, making the process more efficient and less time-consuming. Members can respond at their convenience, with fewer concerns about information privacy.

4. Many-to-One and Group Action Options:

These tools enable care teams to reach multiple members with the same message templates, ensuring that more members receive timely and necessary healthcare communications.

Expanding the Reach of Care Management

Traditional care management methods, such as telephonic outreach, often fall short of effectively engaging members. Long phone calls not only frustrate members but also hinder care managers from practicing at the top of their license. One large Blue Cross Blue Shield plan encountered these challenges head-on.

The health plan’s existing care management processes made it difficult to scale resources and engage with more members, necessitating a modern solution. Using Wellframe, care managers were able to leverage digital channels to increase member touchpoints and establish trusted relationships with members, leading to improved engagement and better health outcomes:

• 91% Increase in Successful Calls: Digital interactions established trust, making members more likely to answer phone calls from care managers and increasing preparedness for those calls.
• 2x Increase in Active Caseload Size: Care managers using Wellframe supported significantly more members than with traditional care management alone.
• 6x Increase in Member Interactions: Digital adoption led to more frequent and meaningful engagements with members.

Measuring Value and ROI of Digital Care Management

The value of digital care management goes beyond immediate savings on care costs. Using digital care management, health plans achieved measurable outcomes in the following areas.

1. Medical Cost Savings

Engaging more members through care management leads to better health outcomes and reduced medical costs for larger populations. By preventing complications and ensuring timely interventions, health plans can save substantially on medical expenses. In one study, health plans were able to save $1,923 per member over a three-month period.

2. HR Cost Avoidance

Expanding care team capacity through digital tools means that care managers can support more members without increasing headcount. This leads to significant HR cost avoidance and better resource allocation.

3. Higher HEDIS/Star Scores

Improving health plan quality scores translates to federal bonus payments (in the case of Medicare) and increased member enrollment across all lines of business. Higher quality scores also enhance the plan’s reputation and competitiveness.

Digital care management is not just a technological advancement; it’s a strategic imperative for modern healthcare organizations. By empowering care teams, enhancing workflow efficiency, and expanding the reach of care managers, solutions like Wellframe enable healthcare organizations to deliver better care at scale.

For healthcare leaders looking to innovate and drive efficiency, integrating digital care management into their operations is a crucial step. It offers a pathway to improved health outcomes, better resource utilization, and a more competitive market position.

Ready to transform your care management approach and achieve better health outcomes for your members?

Discover how Wellframe’s digital care management solutions can enhance efficiency, reduce administrative burdens, and improve member satisfaction.

Watch our on-demand webinar, “Activate Today’s Medicare Member: Effective Engagement Strategies” at any time on our website.