Care management programs typically employ a group of licensed clinicians who are responsible for both reaching out to members and engaging them toward improved outcomes. But a significant portion of the care manager’s time is spent calling members—many of whom do not answer—and completing administrative tasks in an effort to document all interactions with members. We’ve also observed that many health insurance plans tend to organize their teams around particular conditions, which can result in siloed information and support alike.
This means that the member doesn’t always get the holistic support they need, and instead must navigate an overwhelming healthcare system to get help with social barriers, understanding their benefits, or coordinating their care. And for the highly skilled care manager, only a fraction of their time is spent actually working with members and providing the support they are trained to deliver.
Based on our experience working with leading health plans, meaningfully engaging more members, more efficiently requires a new staffing approach.