Closing Care Gaps and Reducing Costs for High-Risk Health Plan Members

Outside of the doctor’s office, managing a chronic condition like diabetes or hypertension falls on the individual. They must take their medications, watch what they eat, juggle multiple doctor’s appointments and lab tests, and know what to do in case of an emergency. And the more complex their health conditions are, the more challenging adherence to treatment protocols becomes.

If they manage their condition well, people living with a chronic condition can often lead relatively normal lives. However, everyone has their own unique set of circumstances influenced by their overall health, treatment complexity and affordability, geographic location, and other factors. These barriers can prevent people from following through on recommended treatment plans, leading to poor health outcomes, repeated emergency department visits and hospital admissions, and higher healthcare costs.

Closing care gaps is essential for improving health outcomes and lowering costs. However, many health plans struggle to actively engage members in their care. These challenges include difficulty reaching members, limited resources to address non-medical needs, and resistance to behavioral change recommendations. According to one study, engagement in care management programs is at just 13% among eligible health plan members.

GoMo Health digital engagement programs have proven to address these challenges utilizing evidence-based behavioral engagement methods to activate members when and where it matters most.

Client Case Study: Fidelis Care

Fidelis Care health plan implemented a digital care management program to support its high-risk Medicaid members with chronic conditions who need advanced health management and care coordination.

Program Objective

Fidelis had several objectives they hoped to achieve, including:

• Reducing emergency room utilization
• Closing care gaps
• Providing a more personalized experience to members while making service delivery more efficient and effective
• Increasing member activation in managing their health and adherence to care plans

The Solution: Fidelis Care Concierge

Members receive important information supporting their self-expressed needs, including easy access to local health, social, and transportation resources, and live 24/7 support. Condition-specific content is customized to each member’s self-expressed priorities and delivered via secure text messages.

Members complete periodic surveys and assessments, allowing the case management team to provide in-the-moment support for evolving needs. When member feedback triggered an escalation or an alert to the clinical care team for immediate intervention, participants were able to receive highly personalized support that ultimately reduced adverse events within the population.

A Success Story: Program Outcomes

The collaboration between Fidelis Care and GoMo Health led to several clinical, operational, and financial improvements:

• 73% decrease in emergency department claims (referred) after starting the program
• 77% decrease in emergency department claims (not referred) after starting the program
• 6-7% closure in care gaps for engagement members across multiple chronic conditions
• 88% decrease in the number of hours spent per month by case management
• 42% reduction in case management costs because of less time spent per case
• 67% of members who responded to surveys said the program is helping them manage their health

Engagement in Action: Partnership Yields Clinical and Financial Success for GoMo Health Clients

Identifying and closing care gaps is vital for enhancing patient care and outcomes, and reducing overall cost of care. More people with chronic conditions receiving recommended care and access to needed resources slows improves adherence to care plans and prevents complications, which ultimately lowers costs and improves member experience.

In our live webinar series, hear directly from GoMo Health clients about how personalized engagement programs helped them achieve significant clinical and financial results.