Payers try to reduce their costs by reducing hospitalizations and emergency department visits for chronic illnesses. Algorithms are developed to identify highest risk members. Using clinical guidelines, call center nurses make outreach calls to a small percentage of high-risk members to educate members about chronic illness. Often, patients do not answer the phone or education efforts do not motivate change. The model is difficult to scale and difficult to reach the most vulnerable.
One large payer implemented the Dayamed Arthur platform for medication adherence to manage chronic illness. The platform allowed the case manager to use video communication, proprietary drug education and integrated biological monitoring to discuss how the medication controls the disease process. The case manager showed the trends in HbA1C as it related to non-adherence scores for a glucose-lowering medication and learned from one member that he did not have transportation to obtain a refill. The case manager was able to request delivery for refills in addition to healthy food supplies to better manage his diabetes.
The predictive analytics in the Arthur platform helped to prioritize the case manager’s workload. The platform allowed the insurer to use gamification to promote app use and thereby improve medication adherence. The digital health intervention improved quality metric scores for medication adherence and improve member satisfaction scores. Over time, the results of the payer’s case management efforts showed a significant reduction in both ED and acute hospital visits and provided the insurer with a unique product for competitive advantage.
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