NextHealth has a proven, systematic and data driven process for improving member activation and engagement across your plan’s full portfolio of disease management programs. We have a particular emphasis on virtual programs to help health plans take advantage of the growth in telehealth created by the COVID pandemic.
NextHealth’s solution drives member activation and engagement into virtual care programs.
This need for activation and engagement appears across high-cost clinical areas like behavioral health and diabetes. NextHealth understands the challenges health plans face in these areas.
Source: NAMI 2020
About 20% of United States population has behavioral health challenges. Approximately 55% percent go without treatment due to provider shortages. Members with untreated behavioral health challenges have far higher costs than those receiving treatment, as much as $3,500 more per member per year (PMPY).
Source: NAMI 2020
More than 34 million people in the United States have diabetes and more than 88 million US adults have pre-diabetes. Diabetic population’s healthcare costs is 2.3x of people without diabetes’. Members receiving virtual diabetes care can drive costs savings of more than $1000 per member per year.
There is a large demand for behavioral health treatment growing further due to the COVID pandemic. However, there is a severe shortage of behavioral health providers. This means we are facing a significant care gap — less than 50% of people with behavioral health challenges receive treatment. This behavioral health treatment gap is an extremely costly problem for health plans.
Sources: Centers for disease control and prevention (CDC), National Alliance on Mental Illness (NAMI), Mckinsey & Co., Ernst & Young, UnitedHealth Group
While NextHealth can’t solve the provider capacity constraints, Our Behavioral Health Solution will reduce total cost of care by driving activation and engagement with virtual providers.
We partnered with one of the nation’s largest healthcare payers to activate members into virtual behavioral health care. The plan saw a 33% increase in the rate at which they were activating members.
There are many population health vendors with solutions for reduction in Diabetes cost. Yet, many members do not activate and engage with these solutions. Based on industry estimates 60% of pre-diabetes and 40% of Type 1 members do not receive treatment.
Thanks to easier access, virtual diabetes care can increase the number of members receiving treatment. Health plans have had limited success activating members into virtual care programs. And even more, many members who engage with virtual providers may not be working with one proven to deliver the best cost and quality outcomes. That is where NextHealth can help.
Demystifying virtual care by activating members into care programs matched with the right provider is only one way Our Diabetes Solution addresses the needs of you and your members.
For these kinds of clinical programs, our solutions deliver insights that influence member behavior at varying stages.
to help a health plan client understand which achieve the best outcomes for their varying groups of members. NextHealth helped the plan identify which interventions delivered the best outcomes and then activated the most ‘impactable’ members into those programs to optimize cost of care benefits.
For another health plan we increased activation and optimized enrollment across multiple members.
We start by identifying impactable members, classifying them into clinically based cohorts, refined by claims, tenure, gender and other factors. We then develop messaging and outreach accordingly.
For example, a member suffering from depression needs different engagement approaches than a member with sleep disorder. Working with clients and partners, we launch outreach, measure the initial effectiveness, and test and learn our way to optimal activation and engagement.