KING OF PRUSSIA, PA — Healthcare analytics platform company Medecision has released an in-depth research report that sheds light on the current state and future trends in utilization management, care management, and population health. The study, titled “The State of Utilization Management, Care Management, and Population Health in 2024,” reveals a significant discrepancy between the perceived importance of personalized healthcare and its actual implementation.
According to the report, a staggering 95% of respondents believe that incorporating personalization into care management is either “moderately important” or “very important.” However, only 34% feel their health plans are “very personalized.” This gap underscores the need for health plan leaders to reassess their strategies and technologies to better meet patient needs.
The study also highlights how inefficient workflows frustrate 68% of the respondents. They cite barriers such as the lack of tools for member engagement and real-time response.
Artificial intelligence (AI) and machine learning are seen as potential game-changers, with 51% of respondents saying they would be “very impactful” in optimizing workflows. This could lead to increased member engagement and improved health outcomes.
Furthermore, the study emphasizes the importance of tracking all touchpoints for high-risk and rising-risk members. About 77% and 60% of respondents, respectively, rated this as “very important.”
As healthcare regulations evolve, 63% of respondents recognize the value of care management and coordination tools in ensuring compliance.
The research concludes that a fundamental transformation is necessary in the healthcare industry. It suggests leveraging broader data sets, advanced technologies, and innovative strategies to enhance efficiency and value in utilization and care management, as well as engagement capabilities.
According to Medecision’s CEO Kenneth Young, “The insights from our research reveal that health plan leaders are at a turning point, grappling with outdated tech and fragmented data. Our response is to empower them with advanced, user-friendly technology that processes real-time data in its raw form, tailored for care and utilization management.”
Strategic use of data, AI, and automation are vital for managing utilization effectively and achieving the necessary personalization to sustain member engagement, reduce costs, and improve health outcomes.
The research was conducted by healthcare consultancy Sage Growth Partners and included 53 leadership respondents from various functions including care management, care coordination, utilization management, and operations.
Stephanie Kovalick, Chief Strategy Officer at Sage Growth Partners, emphasizes the importance of integrating a variety of data types, including medical, social, or behavioral, to create a comprehensive view of individual members. She stresses the need for health plans to implement new technology and leading-edge tools to help improve outcomes for members, prevent unnecessary hospitalizations, and reduce avoidable high-risk events.
This report serves as a wake-up call for health plan leaders to reassess their strategies, embrace innovative technologies, and harness the power of data to provide personalized, efficient, and effective care for their members.
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