Uncovering the Value of Member-PCP Relationships

06/06/2016

Improve health outcomes; lower the cost of care. It’s the mantra of the healthcare industry, and as the matrix of solutions grows in complexity, one healthcare basic delivers on both objectives: the member-primary care provider (PCP) relationship. 

The member-PCP relationship, and its function in preventive care, condition management and care coordination, is markedly valuable. In fact, a Journal of Health Affairs study found that when members have PCPs, disease management improves, healthcare costs decline and member/patient satisfaction rises. Unfortunately, many members don’t have an established PCP nor are they aware of the importance of such a relationship. As a health plan, how can you inform members of this critical component and encourage them to establish a relationship with a PCP? One option is to employ a partner such as Altegra Health, who offers decades of expertise in member engagement.

Altegra Health’s SMART Appointment SchedulingTM (SMAS) increases member engagement by functioning as a liaison between members and providers, closing the relationship gap and ensuring that care needs are met. Through automated and live communication, SMAS educates members on the value of primary care while encouraging and assisting them with scheduling appointments. SMAS also provides both members and providers with care-gap information to be addressed during the visit. Following their appointment, members receive a follow-up call to confirm their attendance and the completeness of the care they received. 

Benefits of SMAS:

Increases health plan revenues 

• Addresses care gaps and improves quality ratings
• Improves risk adjustment accuracy  

• Expands outreach through automation
• Averts costly escalation of health issues 

• Targeted education, monitoring and connection to live assistance

• Delivers personalized health education to members
• Facilitates PCP appointment scheduling 
• Identifies a PCP when a member doesn’t have one 

• Provides concierge-style service -- positively impacting member perception of health plan