Market Brief

Care Management

Industry changes are generating a new set of critical needs for health plans:

  • Care coordination and management of at-risk populations
  • Promoting member engagement with proactive outreach
  • Delivering an excellent experience to patients and providers

The result is an imperative for health plans to transform the way they do business. What was once status quo has now become a dynamic, fast-moving landscape.

There is pressure on health insurers to provide the highest quality of care with improved metrics, and at the same time lower administrative and clinical costs. The shift to new business models, including value-based payments and benefits, ACOs and insurance exchanges has generated new requirements. And with raised expectations by consumers of a customer experience similar to that provided by other industries, the need to stay compliant in the face of evolving regulatory pressures and expanding government programs such as Medicare and Medicaid, it has become harder than ever before for health insurers to stay competitive. 

According to Gartner, “The move to become a digital payer, though complex, is essential.” The ability to harness all available information, initiate proactive health actions and communications, provide an optimized customer experience and connect everyone involved in the healthcare delivery cycle in real-time, all while controlling costs, is now critical for success.

Driving member engagement, identifying and managing high risk populations for quality outcomes and providing a delightful customer experience requires an organizational shift that includes people, process and next-generation care technology. Present and future needs must be considered as the transformation can be significant. In a recent State of the Payor Survey, 73% of healthcare executives stated their intention to use technology to transform their organizations. 

The most transformative health plans are using the award winning HealthRules product suite from HealthEdge to stay ahead of market pressures and drive the organizational change necessary to succeed.

For more than ten years, health insurers implementing the HealthRules CareManager solution have proactively reached out to patients to improve engagement, launched effective care coordination initiatives resulting in a happier and healthier member population, increased quality measures and reduced clinical and administrative costs. 

Join the growing ranks of leading health plans transforming their place in the dynamic healthcare marketplace.


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