Boosting Patient/Member Engagement For Value-based Performance: Why Leaning Into Technology Matters More Than Ever

Revenue tied to value-based care contracts is growing. The latest data reveal that 14% of U.S. provider reimbursement is tied to capitated risk models, compared to only 7% three years ago.  At the same time, shifts in federal policy — particularly around Medicaid eligibility and plan continuity — are adding new urgency to efforts that keep patients actively engaged in their care.

As the financial stakes rise, many healthcare organizations face challenges activating scalable and consistent patient engagement across large, diverse patient populations. One of the greatest barriers to value-based performance occurs when healthcare organizations struggle to help patients take the right steps to improve their health. This is especially true when a provider organization must determine how to build connections with members who have never had an encounter but are assigned to the physician’s panel via a managed care health plan.

It’s an area where health plans and providers can work together to better leverage technology and data analytics. Advanced solutions that create targeted communications will position healthcare organizations to increase annual screening rates and strengthen continuity of care. Additionally, tools that equip providers with key information to better prepare for upcoming patient visits help foster better provider-patient discussions to maximize limited time and close gaps in care. 

The power of data-driven engagement

Even as healthcare leaders acknowledge a pickup in momentum toward value-based care, a 2024 Advisory Board survey suggests that provider readiness remains a key issue when it comes to resources, capital and consistent executive alignment. 

Technology remains central to readiness, and use of data and analytics — including support from artificial intelligence — will continue as an important enabler of success for sustainable risk-bearing strategies. It is why leading providers and health plans are turning to population health platforms that integrate with EHRs and deliver advanced functionality to drive outreach.

For example, when a patient has not had a wellness visit in more than a year, this triggers an alert in the population health management platform. The patient automatically receives an orchestrated sequence of secure text messages, encouraging them to make an appointment, whether by phone or via scheduling link. 

Additionally, this type of automated outreach ensures patients do not miss important timeframes for Medicaid redetermination and health plan reenrollment. With evolving federal guidelines placing greater responsibility on patients to maintain their coverage, having automated, near real-time outreach capabilities is no longer a nice-to-have—it’s essential for keeping individuals connected to care.

In instances where a health plan member is assigned but has not established care with a provider, a personalized text reminds the member of their health plan benefit and offers to assist in scheduling a visit. Once the visit is scheduled, patients automatically stop receiving messages, thanks to data integration with the EHR. If the patient does not show up for the appointment, the messages start again.

This type of “set it and forget it” solution ensures staff do not have to manually move data between tools or call patients to engage them. It also leverages a tool most American adults already own: a cell phone. Data from Pew Research indicate 98% of adults own a cell phone of some type, with 91% owning a smart phone.

Better outcomes through patient visit planning

As healthcare embraces value-based care, data-driven, targeted patient outreach helps close gaps in care that impact performance. In tandem with this more proactive engagement, providers should also leverage technology that supports patient visit planning to ensure time with patients is thorough and optimized. 

Care team members armed with daily patient and appointment-specific information can huddle in the morning to identify, plan and prioritize what needs to be addressed with each patient. Alerts ensure providers don’t miss immunizations or screenings that are due, preventive services such as cancer screenings or A1c tests, and key timeframes for ensuring continuity of care such as Medicaid redetermination and health plan reenrollment. The right solution can also identify patient risk factors, such as smoking, obesity, mental health, and social challenges that might influence care and treatment decisions. 

Proactive patient visit planning empowers busy providers to intervene earlier in treating chronic conditions, reducing the need for more intensive treatments later and avoiding extended inpatient care. For example, one integrated ambulatory and inpatient hospital in the Midwest using tools to support pre-visit planning addressed nearly three times more diabetes A1c and depression screening gaps than it did without the daily guidance.

Technology plus collaboration for better VBC outcomes

As risk-bearing contracts reach higher percentages of overall revenue potential, providers and health plans must collaborate to achieve and maintain a healthy bottom line. Targeted outreach and more proactive visit planning to optimize provider-patient time will be important factors to laying the right foundation for success. Health plans and providers that adopt a technology-driven, collaborative approach stand to achieve higher clinical quality measure performance, risk adjustment factor recapture rates, and cost savings, all while producing better health outcomes — a win-win for all involved.

Source: metamorworks, Getty Images

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