From the desk of Barb Hayes, Altheia’s Chief Growth Officer.

Because we do not have a national healthcare system, we are constantly creating churn given the vast amount of insurance fluctuation.  In fact, people change jobs – and therefore health plans – on average 5-7 times in a lifetime.  Also, 10,000 people per day age into Medicare.  Many have a rotating door going in and out of Medicaid depending on current income levels – resulting in state exchange flux.  And every time we change insurance plans or programs, we often change providers given stipulated networks.  It would be one thing if everyone was healthy, but these days 60% of the population has at least one chronic condition (40% have two or more) – meaning we are creating care blind spots and care disruptions since there is no seamless integration between systems. 

This constant churn translates into unknown risk and potentially unmanaged care for both payers and providers, not to mention the operational inefficiency that comes with these changes:

• Individuals are saddled with fragmented data, and having to start over with information sharing for medical conditions, prescription drugs, prior authorizations, etc.;
• Changing providers means starting from square one – taxing both parties clinically and administratively – often leading to system waste, redundant utilization, higher costs and just plain friction;
• Payers wait roughly 12 (or more) months to amass sufficient claims to assess clinical needs; care managers cannot engage with treatment plans or begin to close gaps during this time.  

Again, if everyone in this new member category were healthy, this might not be a big deal – but we all know this is not the case.  On average, twenty percent of the population is in the rising or high-risk category – driving 80% of the costs – so care continuation & management is critical since 5-15% of this spend can be managed out.  And not only costly, chronic conditions impact absenteeism and productivity even when properly managed – which is all exasperated through non-adherence.

What are new employees/members costing you?  How can you target the right folks to fast-track care management and care continuity?  What if we armed patients with the data you need to run your business effectively?  Let’s not miss an opportunity.