Narrowing Care Gaps: A Measured, Strategic Approach to Engagement

Published On: February 16th, 20233 min read

Patient noncompliance is a costly reality that insurance payers are all too familiar with. Foregoing annual wellness exams and physicals, overlooking problematic symptoms, ignoring physician advice – such noncompliance in your population can lead to chronic illness, which takes up a stunning 90 percent of national healthcare expenditure and costs health insurers as much as $18,000 per member each year.


The good news: An estimated 36 percent of that cost is preventable. At DMI, our experience shows that a lot of noncompliance can be resolved with effective member engagement. Engaged customers are more likely to maintain treatment plans, proactively seek medical advice, monitor their own health, and stay with their payer. When organizations are able to meaningfully connect with their enrollees, the care gaps begin to close and costs of chronic care go down.


Are you getting the most out of your investments in member engagement? Here are four steps for a more strategic, patient-centered approach to engagement to help close care gaps:


Step One: Identify prevalent chronic conditions in your customer population and create cohorts based on these trends.

Consider creating cohorts based on the following: customers at risk for a given condition; customers with a given condition; and customers with a poorly managed condition. Then choose to focus first on cohorts with the largest opportunity for impact. For example, a payer may identify cohorts for diabetes, cancer and high blood pressure. Because 30 percent of the payer’s population has high blood pressure, the payer may choose to prioritize that cohort for engagement in order to maximize impact both to the payer’s population and also to its bottom line.


Step Two: Ideate approaches to generate engagement with prioritized cohorts.

Dig deep on understanding the needs and challenges of each of your organization’s focus cohorts. Brainstorm potential interventions and determine the channels through which to most effectively engage. Then prioritize interventions to maximize impact and ROI. Critical in this phase is determining the most appropriate way to reach customers based on their behavior and preferences. Go beyond identifying the method of delivery. Think also about timing – what time of day does the patient need to receive this message? If they have a known reticence to visit with physicians, think about messaging – what sort of information will need to be communicated and how should the information be packaged?


Step Three: Validate interventions to ensure value.

Clearly define the details of each intervention and hypothesize the business impact. Then create a plan to track intervention outcomes against objectives and develop a roadmap to guide implementation. During this phase, leadership might be eager to roll out the campaign without sufficient planning. The danger: Your organization could lack the preparation needed to nimbly adapt and iterate. At DMI, we challenge our customers to anticipate the value and impact of each intervention – and to identify what is needed in order to achieve a specific outcome.


Step Four: Execute against the roadmap while measuring outcomes and identifying opportunities to improve.

In this implementation phase, it is critical for organizations to measure and adapt as needed in order to realize success. Analyzing the initial outcomes will unlock wisdom and insights crucial for the evolution of your engagement strategy and the iterations of your interventions.

Is your organization in need of a strategic partner to expedite closing care gaps in your population? Connect with our team: We know how to build meaningful engagement with your customers and can help you optimize your return on investment.