The Financial Risk to Insurance Payers When Care Gaps Widen Among Member Populations

Ask insurance payers if they would rather cover preventative care or reactive treatment and they’ll tell you (kindly, of course) to get your head checked out. After all, the answer’s fairly obvious: Reactive treatment, on average, costs 76% more than preventative care.

And yet: Many payers settle for the higher costs of reactive treatment when they fail to strategically and effectively engage their member population – increasing the risk for new care gaps that can grow into costly chronic conditions.

Add to this the post-pandemic reality that the numbers of people getting preventative screenings and routine care remain below pre-pandemic levels.

Consider these additional facts highlighting the high financial consequences of failing to close care gaps:

• Up to 25% of hospital and nursing home admissions are the result of patient noncompliance with physician recommendations.
• Members with just a single chronic condition are three times more expensive to insure. Those with five or more conditions cost payers more than $18,000 annually per member.

Quite simply, payers who get preventative intervention right benefit from cheaper, long-term positive health outcomes.

Ineffective member engagement can take on a variety of different forms.

• Having no strategy means you are making very little effort to close gaps in care and are therefore not engaging with customers.
  A generic approach might look like sending the same, non-personalized messages regularly a few times a year.
• Perhaps your strategy has too narrow a focus, leveraging just one or two traditional channels—such as paper letters or emails—and, thus, has not made a noticeable change to claims data.
• Or maybe your company is experiencing poor engagement, where the vast majority of members are not opening emails, clicking links to preventative advice, or interacting with social posts.

In any of these cases, the lack of an optimized engagement strategy leaves your organization ill-prepared to combat the rising chronic disease crisis.

If your organization does not yet have an omnichannel customer engagement strategy in place to address care gaps, there are steps you can take right now to offset the risk of ballooning medical costs.

1. Take a good look at the data. Evaluate your claims data and understand where your costs are going today. Is your organization making an effort to reach customers diagnosed with or at risk for these conditions?
2. Analyze the outgoing messaging. Review letters, emails, landing pages, even social posts. Then analyze the outcomes of each channel. What platform has been most effective? What type of content seems to resonate with your members?
3. Hypothesize why certain engagement efforts have been less successful. Are you investing in the right interventions? Is your engagement customer-centric, or just convenient for the business?

Your organization can potentially save millions by ramping up the quality of your preventative care outreach and engagement efforts.

If you’d like to hear more about how DMI can help your organization more effectively close care gaps, read our strategy for engaging strategically with your population.