Payers must actively remove obstacles between medical and drug benefit teams to improve provider and clinician alignment and enhance the member experience while meeting business objectives. The complexity of pharmaceutical decision-making and medical treatments increasingly highlights this need. When payer teams establish a foundation of clinical information and align medication and medical data, they can make informed business decisions in a modern healthcare context, creating more opportunities to enhance the member experience.
Access to Real-time Healthcare Data Enhances Patient Satisfaction
To develop timely solutions and choose the best course of action for their patients and members, Payers and Providers should coordinate their viewpoints. Payers face challenges in this coordination due to the rapid advancement of medical knowledge, the record number of new FDA approvals, and the unprecedented expenditures on specialty medications. In addition to lowering friction, providing payer teams with access to real-time data that unifies different electronic systems supports three main downstream benefits that directly impact the member experience: encouraging member outreach and enabling mass customization of health content.
1. Using Evidence-based Practice to Drive Collaboration in Healthcare
Aligned drug and medical data facilitates collaboration among many stakeholders such as payers, providers, and pharmacy benefit managers (PBMs). This collaboration produces a unified ecosystem that promotes a comprehensive and reliable member experience. One important area is the patent experience, and pharmacists have a crucial role in shaping this experience. Giving them aligned data can help them have a better experience with medication adherence, which is measured by triple-weighted star ratings.
2. Integrated Data Relating to New Drug Releases
Both payers and providers must control the usage of expensive new treatments. However, information silos may hinder provider communications and payer management. Dismantling these silos enables payers to better assess treatments, control expenses, and enhance member satisfaction and care. This endeavor becomes even more challenging when new drugs outpace evidence and contradictory or unclear rules develop surrounding their use. To address this problem, improved technology integration that prioritizes therapeutic and coverage decisions is necessary to keep up with highly sought-after medications. GLP-1 medications, for instance, are gaining popularity. Between 2017 and 2021, the use of these medications grew 40 times, potentially affecting 2-3% of the US population. This sharp rise in use raises the possibility of coordination gaps between physicians and payers, as they may not be using the same clinical advice or evidence. This dynamic leaves members caught in the middle, which may lead to problems with policy coverage. To ensure a seamless member experience with GLP-1s, payer benefit teams, and providers must coordinate clinical data and evidence-based information.
3. Enhanced Collaboration with Providers
Payers and providers must coordinate to create a customized member experience. When care management teams use the same data as clinicians, members are more likely to receive consistent communications about therapies, wellness, and general care. This collaboration leads to better results, more consistent outcomes, and higher member satisfaction for all stakeholders. Care management teams should support patient education initiatives from providers and ensure that member education materials are based on data that is supported by evidence.
Precise Data Alignment Necessitates the Right Technological Tools
The enormous volume of data exchanged between payers and providers may hinder true alignment and better benefit design. Payers should seek a reliable vendor partner with technology tailored to their requirements. To optimize service delivery and create a superior member that remains consistent across payer and provider interactions, they should look for solutions that leverage data integration to coordinate payer evidence and data with provider conversation tracks and scripts.
Conclusion
The cornerstone of better care delivery and a highly regarded member experience is data alignment driven by real-time evidence. This is achieved through the implementation of healthcare cost management techniques, coordinated care, and superior outcomes. Even the most difficult member groups benefit from this degree of evidence-based support since it promotes trust, involvement, and ultimately Satisfaction.
Read Whitepaper Use Of Real-Time Analytics In Population Health
