Medhealth Review

Why providers need to rethink beneficiary engagement

Too often, we think of patients as passive—both as healthcare providers and as patients ourselves. As healthcare providers, we perform tests on, provide treatments to and write prescriptions for patients. We swoop in and out, temporarily bandaging acute problems rather than seeking out the underlying causes. As patients, we often go to the doctor once a year for 15–20 minutes and call it good; however, health doesn’t happen in a vacuum or in quarter-hour intervals; health happens all day, every day, everywhere. Rethinking beneficiary engagement can help improve health outcomes and reduce costs with deep, trusting relationships that emphasize proactivity while removing barriers to care.

What is beneficiary engagement?

Beneficiary engagement can mean different things to different people. Here’s how I define it: a beneficiary’s willingness—or unwillingness—to actively participate and/or allow others to participate in their health journey. Healthcare providers play influential roles in helping to educate patients about their role and responsibility in their own health and helping to make access to care frictionless.

The top strategy to boosting beneficiary engagement as a provider is really wrapping your arms around a patient so they feel supported, respected and understood. In such a situation, patients can feel empowered to be a true partner in their health. Granted, this is a tall order. Many providers are in production mode, seeing patients on a veritable assembly line in the fee-for-service model. Transitioning to value-based care can help providers get back to what they got into medicine to do: help people.

What isn’t beneficiary engagement?

Too often, I hear providers say that beneficiary engagement is about medication adherence or treatment compliance. Don’t get me wrong, these factors are important, but they can also provide a false sense of security for the provider. The trouble is: a lot of patients feel ashamed or embarrassed by their situations. It takes gaining a patient’s deep trust to get them to open up, especially when it comes to circumstances or experiences that feel taboo (like not having a safe or steady place to live or enough food to eat).

Here’s an example. We saw a patient who kept being admitted to the hospital for asthma exasperation. Nobody could figure out what was going on. She seemed to be following her medication and treatment plans, yet she kept ending up in the hospital month after month. We did a house call to see if we could find anything in her home and, sure enough, she had a rodent infestation. No amount of medication adherence or treatment compliance was going to change the underlying cause of her problem. She needed an exterminator but couldn’t afford one. We connected her with services to help pay for fumigation, and, once that happened, she went an entire year without a relapse.

How does ilumed streamline beneficiary engagement for providers?

Providers and their staff are often stretched beyond their bandwidth, especially after the global pandemic. Physician burnout is at an all-time high, while the workforce is shrinking. Providers are expected to do more with less time and less staff. It might not be logistically or financially feasible for them to hire outreach staff, whether clinical or non-clinical. That’s where ilumed comes in. We act as an extension of the provider’s office, supporting both the staff and patient panels with wrap-around services.

Non-clinical outreach teams

We assign a non-clinical member outreach personnel to every beneficiary who is part of our ACO REACH network to provide white-glove, concierge-level service. If someone needs help scheduling appointments or transportation to and from appointments, we make it happen. If someone is experiencing food insecurity, financial strain or another barrier, we help connect them to services in their area. For example, if someone is going to have knee surgery, our team helps them prepare for it in advance, and we follow up afterward to ensure things are going well post-discharge. We help beneficiaries feel like they have a true partner when it comes to navigating the healthcare system. We also have social workers on staff to support many of the other needs/barriers our beneficiaries have.

Clinical case management team

Managing chronic conditions is complex. It takes year-round, frequent communication, education and support. ilumed provides full-scale clinical case management support to our network of providers, everything from chronic disease management to transition of care management to nutritional education, medication adherence and social support. Our team helps transform provider practices for the better.

Proprietary BrainStream platform 

Powered by artificial intelligence and predictive data analytics, our proprietary BrainStream platform combines claims data, risk scoring, beneficiary social determinants of health (SDoH) information along with clinical information, giving us unprecedented insight into individual- and population-level health trends with early warning alerts. We flag those beneficiaries who might be at risk with chronic conditions, food insecurity or transportation needs before those patients present with problems. We can see if an entire community is experiencing an uptick in a certain disease, which alerts us to dig deeper into what environmental or social factors could be contributing.

Strategy, flexibility and experience

Our care strategy is rooted in value-based care. We invest in our staff and resources to ensure we can help providers make a smooth transition from fee-for-service to value-based care. Our proven approach results in fewer hospital and emergency-room admissions, improved health outcomes and savings for beneficiaries, providers and Medicare. The ACO REACH model incentivizes smart and proactive care.

ilumed has the flexibility to eliminate many barriers to health and access to care. Whether it’s food insecurity or lack of transportation, the ACO REACH Model allows ilumed to provide programs and resources to overcome these inequities.

ilumed’s leadership team has worked together for decades, implementing numerous successful programs in multiple states at every scale. We know what needs to be done and how to do it because we’ve been on the front lines of a provider’s office. We’ve been on the payer side and we’ve experienced the healthcare system’s gaps firsthand. We’re able to collate these experiences together to create a sum greater than its parts. We know how to heal healthcare the right way. Get in touch.

By Steve Hojnacki, Executive Vice President of Strategic Development

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