While seen as valuable strategies in the effort to improve health and control costs, care management initiatives today struggle with low enrollment, high administrative costs and a lack of credible outcomes. Many healthcare leaders attribute these problems to:
- Ineffective targeting and matching of programs to population segments,
- Lack of effective and focused outreach and enrollment efforts, and
- A one-size-fits-all approach to program design.
SCIOinspire's focus is on improving care management results through program design, operational efficiencies, staff training, and development and decision support systems. We offer tools to facilitate the key drivers of program financial success: identification, engagement, and impact and measurement of disease management programs.
Experts agree that, in reality, care management programs are a collection of activities and components combined in similar but often strategically different ways and in different quantities. Often, the overall value of a program is greater than the sum of its parts. This means that to optimize effectiveness and maximize success, each component must be well defined and well supported to produce superior performance. SCIOinspire Care Management solutions help providers and purchasers of these programs improve operational efficiency and boost results at all stages along the value chain including:
- Customized Program Design and Evaluation - providing a structured, objective view of opportunities, issues and potential risks with current or proposed program design and implementation.
- Opportunity Assessment - evaluating the potential and estimating the performance of care management programs via actuarially-based, methodologically-sound analyses. By turning claims data into actionable information, SCIOinspire creates a foundation for informed benefit design, vendor selection if applicable and clinical analysis.
- Outcomes Analysis - delivering highly credible, actionable outcomes data. Our skilled team brings extensive experience in care management program design, implementation and financial outcomes analyses to the development of the most appropriate and relevant evaluation methodology.
- Member Engagement - Just InTime® Wellness is an innovative Member engagement solution that engages members in their health by identifying gaps in care, and uses technology to reach them with personalized information that matters.
Because care management represents the largest single outsourcing expense for purchasers, they are challenged by:
- The need to quantify clinical, cost, efficiency and ROI results
- Identification of applicable savings-calculation methodology
- Difficulty of collecting relevant data on reference population, equivalence, consistency and exposure
- Incorrect conclusions based on ignored or inadequately addressed data
- Inefficient clinical and operational program design
- Establishing and meeting program objectives
- Low enrollment, high drop-out rates due to inadequacy of coaching resources or ineffective outreach
SCIOinspire offers targeted, member-direct, cost-effective, scalable solutions that include:
- Integrated, sophisticated data analytics to drive enrollment initiatives
- Targeted outreach driven by predictive modeling and risk stratification
- Experienced enrollment specialists to optimize outreach and HRA completion
- Reminder services for medication adherence
- Call center capability for enrollment, outreach, health risk survey assistance
- Multi-channel communication options: Web-based, paper and phone surveys
- Personalized, disease-specific education materials for wellness and chronic disease management programs
- Online coaching services; assess readiness to change, set goals, offer ongoing coach interaction for improved member engagement and outcomes
- Program promotion and member triage to appropriate care management programs
- Comprehensive reporting to measure both clinical and financial outcomes
- Care Management Support Services
