Vendor Spotlight on Carenet: Member Experience Key Differentiator in Post-Reform World

With the seismic changes occurring in the healthcare arena, it’s more critical than ever for providers and payers to reduce or contain costs while providing high quality care. To remain competitive in the post-reform marketplace, healthcare organizations must be equipped with scalable solutions, advanced customer relationship management systems, and a flexible, easily extensible infrastructure to meet the demands – and anticipate the needs – of their growing member population.

While extendable solutions, systems, and infrastructure are absolutely vital for accommodating future expansion, the key to success is the ability to use technology and actionable data to elevate the member experience, according to Carenet Healthcare Services. Cultivating trusted member relationships that engage, educate, and empower people to take a more active role in their healthcare will dramatically affect operational, clinical, and financial outcomes.

“When launching a new program or evaluating a current service, two top strategic planning questions to ask are ‘Does it reduce or control costs while providing quality?’ and ‘Can I show the savings?’” said John Erwin, Carenet president. “With a singular focus on healthcare for 25 years, Carenet knows how to formulate forward-thinking, cost-effective solutions that transform the member experience and deliver measurable results.”

Engagement Success Formula: With the majority of healthcare-related costs driven by member decisions, it’s imperative to empower people to make the wisest choice for their health and their wallet. Carenet’s engagement solutions combine three essential elements: an expert team, personalized support, and actionable data. These three components significantly increase member education and engagement, drive positive behavior change, and provide a higher return on investment for everyone

Carenet’s team of engagement specialists, registered nurses, and care advocates provides a distinctive level of personalized support that builds trust, loyalty, and accountability. As a result, members are more communicative, receptive to guidance, and motivated to take action.

“Every day, the people we connect with express their gratitude for our assistance,” said Vikie Spulak, Carenet executive vice president. “They are often surprised to hear a caring voice on the other end of the line offering to share more affordable, convenient healthcare options, whether it’s switching to a generic drug, enrolling in a disease-management program, or using ER alternatives.”

It’s during these personal interactions that Carenet collects comprehensive data on individuals, including everything from health risk assessments, prescriptions, claims information, and gaps in care. By combining this actionable data with finely-tuned engagement practices, Carenet is able to maximize every member interaction and proactively identify health challenges before they become problems.

For Example:

Education Elevates Exam Compliance by 160%:To elevate Medicare member compliance with annual physical exams, a leading health plan turned to Carenet. By increasing member engagement and education on the importance of preventative care, the plan could detect disease states earlier. This ultimately improved their outcomes, HEDIS measures, and star rating.

Carenet designed a customized, multi-touch outreach solution driven by their engagement specialists. The team educated members on exam and screening benefits, facilitated appointment setting, and delivered a high level of personalized support. As a result, more than a third of the members scheduled an exam, elevating compliance by 160 percent.

Drug Switch Cuts $4.7 Million: A major health plan worked with Carenet to lower costs by informing members of generic statin drug savings. A multi-channel engagement program created a trusted connection with members, educated them on generic drug benefits, and switched their prescriptions seamlessly. Carenet achieved a 440 percent lift over the plan’s in-house campaign. More than 60 percent of the members benefitted from the switch, saving them $250 to $500 per yearly prescription. The program yielded an annual savings of $4.7 million for the plan and $1.1 million for members.

Personal Outreach Reduces Readmissions: Carenet joined forces with a top health plan to reduce hospital readmissions and associated costs by identifying at-risk discharged patients and enrolling them into case management programs. Full integration with the plan’s customer relationship management system gave Carenet unfettered access to patient data; this enabled them to provide personalized support within the critical 72-hour discharge window.

Engagement specialists reinforced care instructions and guided patients to a case manager, a care advocate, nurse triage, or utilization management when appropriate. Carenet successfully engaged post-discharge patients and referred 83 percent to case and utilization management. The plan’s readmission rate declined and continues to trend downward, saving everyone money while improving patient care.

Pivotal Position: Carenet plays a pivotal role in coordinating care for all the major stakeholders. The company’s goal of working with members, providers, and payers every day enables it to understand and address each group’s challenges and opportunities. “Thanks to our daily exposure and in-depth experience, we effectively unite everyone to produce a more efficient, rewarding experience – and exponentially higher value for all,” said Spulak.

As the country embarks on a new era in healthcare, Carenet is positioned to lead companies through the changes the post-reform world presents. “Our performance-driven clinical approach to healthcare cost management is propelled by our progressive technology and proven engagement tactics that bolster the member experience,” Erwin said. “With consumer choice skyrocketing, customer experience will be the key competitive differentiator among organizations.”

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[From the August/September 2012 issue of AnswerStat magazine]