Stomachs of health plan executives turn as surges in avoidable ED utilization and inpatient hospitalization among DSNP members spike, wreaking havoc on their margins and lessening chances of winning the next bid. So, rather than investing in short-term solutions, how can plans get to the root of the issue, improve quality measures, and generate attractive cost-saving data to win an RFP bid?
The answer is innovative, scalable, and low data usage technology.
Let’s start with the problem. Millions of FBDE (Full Benefit Dual-Eligible) individuals experience both physical and behavioral health disabilities – creating difficult barriers to accessing the care they need.
Low member engagement culprits: 3 barriers to navigating care
The ‘dual’ in Dual Special Needs
Greater social risk factors
- Food insecurity
- Lower education levels
- Health literacy challenges
- Housing insecurity and homelessness
- Lack of transportation to access care appointments
- Inability to access childcare and early childhood education
Between an inability to read prescription drug instructions and the anxiety of securing weekly meals, payers recognize that social barriers to care undoubtedly contribute to poorer health outcomes and, in turn, avoidable ED service utilization.
Plans have started placing greater focus on SDoH needs to ensure members are adequately served from a whole-person care perspective. The challenge is capturing needs in the moments outside of the traditional care setting, which contribute to about 80 to 90 percent of member health outcomes.4
Higher illness susceptibility, soaring COVID hospital utilization
Recent CMS (Centers for Medicare and Medicaid) data further confirms that COVID-19 related hospitalization trends for dual members have notably exceeded those of individuals covered solely under Medicare (see image below).
Using technology to engage DSNP members
Scalable technology to strengthen models of care
Technology solutions for disabled and homebound members
Avoid unnecessary inpatient and ED utilization with SDOH interventions
2. June 2020 Report to Congress on Medicaid and CHIP by macpac.gov
3. Report: Integrated Care Models are Better for Dual-Eligibles by Arnold Ventures
4. Social Determinants of Health 101 for Health Care: Five Plus Five by National Academy of Medicine