Health plans bear significant responsibility for the well-being of millions of patients across the nation, and a crucial aspect of every payer’s mission is to consistently deliver the highest standard of care to their members. However, the task has become increasingly challenging as a sizable segment of the population ages and develops comorbidities. A byproduct of these changes has led to a substantial surge in drug spending for health plans. According to the Kaiser Family Foundation, more than 50% of adults over the age of 65 and another 32% of adults between the ages of 50-64 now take four or more prescription drugs to manage their health.1 At the same time, net spending on prescription drugs in the United States grew 5.3% in 2022 and has soared by over $100 billion in the past five years to a staggering $429 billion.2 What was once a very small component of total payer spend has evolved into a meaningful, complex driver of financial performance and patient health outcomes.
To help better manage these medically complex patients and control avoidable costs, many payers have invested in highly skilled pharmacy teams to engage with patients on health-related topics from annual vaccination initiatives to medication adherence. However, getting these teams access to the right member data at the right time can be challenging – especially as many payers rely on static Excel spreadsheets or rigid Access databases.
With over a decade of experience supporting health plan pharmacy benefit management, experts on the Clinical Pharmacy team at HealthPlan Data Solutions have complied five best practices to “supercharge” your campaign management strategies and drive improvement of key quality measures such as Medicare STARS, PQA, HEDIS, and CAHPS.
- Eliminate duplicate member outreach
Coordinating member outreach attempts is important because it is quite common for members to qualify for multiple pharmacy campaigns. Failing to coordinate outreach efforts across interventions can result in members receiving multiple contact attempts. While well intended, “crossing your lines” in this way can cause member abrasion and waste valuable pharmacy staff time.
It is essential for pharmacy teams to maintain continuous visibility into all member campaign interactions, especially when members qualify for multiple interventions. Doing so will result in a more streamlined outreach workflow, while also increasing the likelihood of successful interventions and improved member satisfaction.
- Stratify skill level by campaign
Pharmacy payers employ staff with a wide array of skill levels, ranging from customer service representatives to pharmacy technicians and staff pharmacists. While some campaigns may require a pharmacist (such as a comprehensive medication reviews or CMR), not all outreach attempts require this level of expertise and using a campaign management tool that offers the flexibility to assign the appropriate staff to campaigns can save a health plan time and money. To best optimize internal resources, quality teams must have the ability to assign campaigns according to the minimum skill level required. Doing so ensures the payer appropriately stratifies clinical resources on a per-intervention basis and eliminates inefficiencies associated with over- or underqualification.
By matching the staff skill level with the intended outreach goals, the pharmacy department can better manage the time of their highest-cost employees and maximize the value of each member touch point.
- Update member information daily
Although many plans rely on static programs such as Excel, these systems can inadvertently create outreach gaps. Whether the member is no longer covered by the plan, already refilled their prescription, or is no longer on a highlighted medication, having the most up to date information is paramount to outreach success. Without daily updates, pharmacy staff can accidentally engage with members that no longer require outreach or fail to engage with members that may have become eligible for outreach after the data was originally accessed.
Having campaign eligibility information update every day is critically important to maximizing staff time and ensuring a positive member engagement experience.
- Record additional information on Social Determinants of Health (SDOH)
Social Determinants of Health (SDoH) is still a rather new focus for payers but can be critically important to better understanding your member’s healthcare experience. Adding and tracking member responses to simple questions like:
- Do you feel safe at home?
- Do you have access to food and clean water?
- Do you have regular access to the internet?
Can help payers paint a clear picture of their member’s potential challenges. By identifying and tracking key metrics on SDoH, payers can ensure they are providing more targeted support for their highest-risk members and improve their overall quality of care.
- Leverage the right medium at the right time to engage with your members
With the availability of call, text, email, application messaging, and more, it is extremely important for plans to make sure they are leveraging the right medium to engage with their members at the right time. A successful campaign strategy should include the proper communication medium in their call center plan.
For example, engaging with a 28-year-old managing one chronic condition may look very different than an engagement plan for 67-year-old managing six medications for multiple chronic conditions. Engaging with the younger individual may include text-based reminders or app push notifications scheduled to deliver after working hours while engaging with the older individual may require a phone call between 9am – 11am. In either situation, matching the right member with the right medium and timeframe dramatically increases both the likelihood of completion and the receptiveness of the member.
Member outreach is a critically important function for today’s payers to master and the task is not getting any easier. Organizations continue to invest considerable time and resources into improving the quality of their pharmacy care, but many still fall into predictable traps that result in wasted staff time and suboptimal member experiences. By implementing dynamic systems, payers can ensure their FTEs maximize time, improve member engagement, and drive positive change to their pharmacy spend.
Interested in exploring what a dynamic campaign management solution could do for your plan’s pharmacy spending and productivity? Contact HealthPlan Data Solutions to learn more about their RevealRx campaign management software.
2IQVIA Institute. The Use of Medicines in the U.S. 2023 Report. Accessed May 30, 2023 https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/the-use-of-medicines-in-the-us-2023/the-use-of-medicines-in-the-us-2023.pdf