Solving health plan challenges: Improving quality of care

Perspective: Better care, lower cost | Capability: All | By: John Hastings

Improving the quality of care is a goal for many health plans regardless of size or line of business. John Hastings, our Chief Growth Officer, shares how we are helping to make that happen.

I’ve spent more than 20 years in the healthcare industry. If there’s one goal that health plans are consistently working to achieve, it’s providing better quality of care for their members. And the health plans that excel in that endeavor often prioritize two strategies in particular.


How are leading health plans enhancing quality of care?


First, these health plans are approaching care holistically, looking at each person’s physical, behavioral, and social drivers of health — what we at Carelon call a whole-health approach. Addressing whole health is critical to improving the overall quality of care, because if one piece of the puzzle is missing or incomplete for someone, it’s likely to impact the other two.

For example, if a person is facing housing insecurity, that can lead to stress and potential mental health challenges. If someone’s behavioral health is not being addressed, that can have a real impact on their physical health. There’s also a strong link between certain chronic conditions and depression rates. Simply looking at someone’s zip code can give you a head start to understanding some of the challenges that they might be facing in their life.

Another way to improve quality of care is by working with members to ensure they are getting the support and care they need at every stage of their healthcare journey. If someone is living with pre-diabetes, let’s help them make lifestyle choices to help stave off diabetes. If someone is facing a chronic condition, let’s make sure they feel supported when it comes to managing their illness, going to medical appointments, and taking their medication. The whole process should feel seamless and integrated, not difficult and disjointed.

Improving quality of care is a goal for all lines of business for health plans; it not only keeps their members healthier, but it’s also good for their financial performance. When it comes to Medicare Advantage, for example, a health plan’s funding is partially dependent on their ability to do things like close gaps in care. Successfully doing so can improve their Star scores and make them more competitive in the market. To see results like these, many health plan leaders are seeking experienced, collaborative partners.


How is Carelon making better quality of care possible?


Carelon supports health plans by enhancing quality and outcomes in numerous ways, all of which fall under our whole-health umbrella. It starts very early with our advocacy capability. That means early and thoughtful engagement with members, using analytics and predictive modeling to identify the people who may have the most complex needs and then offering proactive healthcare support.

We also offer solutions, ranging from advanced primary care to compassionate palliative care, to support and drive better outcomes. In the behavioral health space, where we have decades of experience, we make it a priority to be present when care and support are needed the most, whether it be for autism, substance use disorder, or any other mental health concerns. We offer prevention and recovery-focused systems of care enhanced by advanced technology and digital tools.

Carelon conducts advanced research and works to promote clinical best practices as well. Our medical and pharmacy benefits management services help ensure that members get the most appropriate, evidence-based care. We rely on our trove of data and expertise to drive analytics and insights that can guide and support members in their healthcare journey.

At the end of the day, when you put together clinical expertise, healthcare industry knowledge, and the latest technology and get them working together to put the right information in the hands of the people making health decisions, you drive better care at scale.


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