Harnessing Change: Integrating Digital with Traditional Care Management Strategy 

As the healthcare industry evolves, health plans face increasing pressures from virtually every area of their businesses. Care management teams are particularly challenged to address these pressures, as they are often charged with managing the most vulnerable and complex members. This is forcing many payers to pursue digital care management best practices to support their traditional care management strategies. Some of the key driving forces behind these innovations include:

• The role of care managers continues to expand as multiple business and payment models emerge.
• Healthcare consumers’ expectations for personalized digital engagement continue to rise.
• Regulatory requirements become more complex and burdensome to follow, while clinician burnout reaches an all-time high.

By transforming traditional care management teams into digital care management teams, payers hope to bring benefits to all stakeholders: members, care managers, and the health plan itself.

However, it’s important for payers to understand that this transformation is not just about implementing modern technology solutions, like HealthEdge GuidingCare® and HealthEdge Wellframe™. It must include a comprehensive approach to organizational change management that ensures the full business objectives are met.

Understanding the Need for Change

The journey toward digital care management begins with recognizing the necessity of change. Health plans must understand why the change is important and align it with the organization’s vision and mission. Without aligning on change management goals, efforts may falter from the outset. Organizations must foster a pervasive culture of change across all levels, involving not only clinical leadership but also IT, data, and community-based partners. Change must be embraced by the entire organization, supported by multilevel activation and champions to push the strategies forward.

Leveraging HealthEdge for Digital Transformation

HealthEdge GuidingCare is a comprehensive care management platform designed to help health plans better support some of their most complex populations. Health plans have found that partnering closely with HealthEdge facilitates seamless integrations and implementations. This partnership can also enable health plans to successfully transition new member populations onto their GuidingCare system and integrate with newly acquired health plans.

For health plans looking to embrace digital care management capabilities, Wellframe offers a comprehensive digital member engagement solution. Health plans that adopt Wellframe experience transformed care delivery, providing nurses with a powerful tool to engage members more effectively. This transition is not without its challenges, as nurses must adapt from traditional telephonic methods to a new digital interface. However, the benefits soon become evident: streamlined processes, increased member engagement, and improved clinical outcomes.

Wellframe’s app enables care managers to provide tailored, member-centric support, including medication reminders and educational content. The efficiency gains are substantial, with care managers able to deliver interventions and follow-ups much faster than through traditional methods. The app also allows for asynchronous communication, giving members the flexibility to engage with their care at their convenience.

The integration of GuidingCare and Wellframe (Care-Wellframe) creates a comprehensive digital care management ecosystem. This care management interoperability ensures that all functions work seamlessly together—without having to swivel between disparate systems. Health plans can leverage this integration to achieve scale without having to expand their care management teams. Automation and digital tools become force multipliers, enabling health plans to provide consistent and high-quality care to their members.

Best Practices for Change Management

Transforming care management involves more than just implementing new technology; it requires a cultural shift within the organization. Health plans must foster a culture that embraces change and transformation while maintaining regulatory compliance and performance measures. This begins with understanding the organization’s capabilities and identifying opportunities for improvement based on data insights.

For example, health plans can leverage data to track clinical quality, resource use, and customer service measures, setting strategic priorities that align with member outcomes. This alignment ensures that everyone in the organization, from customer care to pharmacy teams, understands their impact on these measures. Training and education play critical roles in empowering staff to contribute to the organization’s goals.

Successful change management involves several best practices:

• Communicate the Why: Over-communicate the reasons for change to ensure all stakeholders understand and buy into the vision.
• Empower Early Adopters: Engage early adopters with input from the team to drive transformation.
• Simplify Architecture: Streamline systems to reduce unnecessary touchpoints and ensure seamless interoperability.
• Foster Collaboration: Encourage collaboration across departments and with external partners to solve problems collectively.
• Embrace Continuous Improvement: View change as an ongoing process of improvement rather than a one-time event.

Measuring Care Management Success

Success in care management transformation can be measured in various ways. For executive leaders, it’s about return on investment (ROI). For case managers, success means effective member interactions and efficient workflows. For administrative teams, it’s about minimizing errors and ensuring regulatory compliance. Health plans must be willing to measure success in different ways than traditional care management metrics, acknowledging both wins and failures as opportunities for growth.

For example, health plans can hold stakeholders accountable to timelines, encouraging collaboration, and giving permission to fail. By creating an environment where staff can raise their hands and seek help, organizations can foster a culture of continuous improvement and innovation.

The Future of Care Management

Automation and digital solutions are today’s key to the future of care management. Care management teams must adapt to the changing healthcare landscape by doing more with fewer resources. Automation and digital care management enable care managers to scale and reach more members, which improves both care manager and member satisfaction.

Integrating digital with traditional care management is a complex but necessary journey for health plans. HealthEdge GuidingCare and Wellframe are at the forefront of this transformation, providing health plans with both the technology and the change management support services necessary to navigate the complexities of today’s healthcare environment. As a result, every stakeholder wins:

• Members: Engage with care managers on their own terms via preferred communication channels, experience more personalized customer service, and experience better health outcomes.
• Care managers: Access real-time clinical and social data to effectively meet members where they are, with the right care and support.
• Health plans: Find new ways to scale care management teams to reach more members, contain costs, improve performance measures (Star ratings), and remain competitive.

To learn more about how HealthEdge can help transform your care management team from traditional care management to digital care management, read our case study, “Next Generation Care Management at Denver Health Medical Plan”.