How one health plan dramatically improved the triple aim
Health Plans

Avoid the high cost of disengaged members

March 17, 2021
How one health plan dramatically improved member engagement, health outcomes and cost savings.
Senior Clinical Transformational Consultant


The high cost of disengaged members

As health plan leaders know all too well, the cost of disengaged members is high in terms of health and financial outcomes. Disengaged members are three times as likely to have unmet medical needs and two times as likely to delay medical care. They are less apt to follow prescribed treatment plans, are likely to have more than five chronic conditions, and have higher hospital readmissions. Low member engagement also leads to higher mortality rates for members who are chronically ill. The impact of medication noncompliance alone by disengaged members is estimated to result in 100,000 preventable deaths and $100 billion in unnecessary medical costs annually.

Conversely, activated and engaged members have more positive outcomes. They have healthier habits including healthy eating and consistent physical activity, and are more likely to receive preventive care. They are also less likely to smoke or have a high BMI, and less likely to be hospitalized or use any emergency services.

Member engagement differences

The positive impact of care coordination and targeted case management

A World Health Organization study of case management and collaborative care for cardiovascular disease and cancer showed less depression and better self-management of physical health for members whose care included integrated collaborative care than those who did not.

What’s more, a J.D. Power study found the single most effective lever of health plan member satisfaction is helpful care coordination. In a separate member health plan study the firm reported proactive cost control and care coordination engagement by health plans drive significant improvement in overall customer satisfaction scores.

The high value of engaged members

As there are clearly strong ties between engagement, improved health outcomes and member satisfaction, it’s important for health plans to strengthen their engagement and case management programs. That said, identifying and prioritizing members who would benefit most from those programs is a struggle for most health plans. But it doesn’t need to be.

With AI-driven identification and stratification tools, member concierge teams and case managers can hone in on rising-risk, chronically or catastrophically ill members and their associated gaps in care.

With AI-driven identification and stratification tools that continuously search across populations for those members most in need of outreach and most at risk for negative health outcomes, member concierge teams and case managers can hone in on rising-risk, chronically or catastrophically ill members and their associated gaps in care.

Once accurately identified and prioritized by need, care teams can develop personalized, effective care plans and better assist in care coordination to achieve member goals and help deliver the best care management services possible.

In the end, targeted, effective engagement, bolstered by next-generation analytics is a win-win for health plans and members. A two-year case study of one client’s advanced care management model combined with Geneia’s identification and stratification model yielded:

  • An estimated cost savings of more than $7,500 per member.
  • $3 in health cost savings for every $1 in administrative cost spent.
  • A 289 percent increase in member engagement.

To learn how, download our health plan case study: Improving the Triple Aim: Next-Generation ID/Strat, Analytics and Engagement.