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Health plan learnings from our COVID-19 efforts

While the US cautiously begins the reopening process, we at CarePort are taking the opportunity to reflect on some lessons learned through our work with both payer and provider clients who have tirelessly managed care during these complex times.

Lesson 1: Health plans need better ways to track members across care settings

Because hospitals and skilled nursing facilities were overwhelmed by COVID-19, many of the traditional methods through which payers gain insight into member admissions and discharges virtually evaporated. For example, utilization management processes were slowed down – or shut off altogether – and on-site care managers and support staff were no longer permitted for safety reasons. Many health plan leaders that we spoke with described the lack of visibility they had into members’ episodes of care, and the associated obstacle of coordinating and managing the necessary follow-up care. Regardless of whether these challenges persist post-COVID-19, it is clear that for payers to provide timely and effective care management and quality improvement, creative solutions that provide virtual access to member transitions across care settings will be critical.

Lesson 2: Effective care management requires better coordination across stakeholders

Even with new regulations set to mandate interoperability, COVID-19 has highlighted the lack of alignment and coordination between stakeholders at all levels of healthcare. Seemingly simple processes – such as understanding whether a skilled nursing facility is willing and able to accept patients with COVID-19 – have proven difficult, causing operational and quality issues downstream. Whether in times of crisis or relative calm, coordinated resources and aligned incentives are critical to success. During COVID-19, CarePort has worked with its customers to help them increase collaboration, communication and transparency across the care continuum to ensure that COVID-19 and non-COVID-19 patients receive appropriate, safe care once they leave the acute care setting.

Lesson 3: Healthcare moves fast, and health plans need partners that can adapt quickly

Whether responding to a global pandemic, a new value-based contract, or a new quality measure, healthcare is constantly evolving. Payers, providers and the technology platforms that they utilize must also be able to evolve quickly to support these changes.

As new sites of care were established to support surging COVID-19 patient volumes, CarePort realized that changes to the platform were needed to quickly to enable the transfer of patients to temporary facilities such as the USNS Comfort and the Javits Center. Product, development and other teams across CarePort mobilized and worked tirelessly to scope and rapidly develop the solutions that our clients needed to continue their critical work on the front lines.

Even the highest performing plans and providers could not have prepared for the full extent of the COVID-19 pandemic, however some of the lessons we have all learned while responding to the outbreak can help establish a stronger foundation for continued improvement moving forward. As we return to our “new normal,” it is critical that we do not lose sight of these learnings.

For more information regarding CarePort and our payer solutions, click here or contact us.

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