Leveraging a Network of RNs Boosts Member Experience, Spending

The healthcare system is buckling under rising costs. The situation will likely worsen as the number of older Americans increases rapidly unless payers and their partners make fundamental care management changes.

Payers have leveraged care management programs in response to value-based care initiatives and the general shift from fee-for-service delivery to more preventative, interventionist care. The latter way of delivering care has started to keep members out of the hospital and other expensive care settings, reducing healthcare spending and improving clinical outcomes. However, the way of providing care even a couple of years ago may be obsolete in the near future.

The population of older Americans wishing to age in place is increasing. Payers need to respond to that to maintain both member experience and any gains they have made with healthcare spending and care quality improvement. At the same time, they need care management programs to care for an older population. With resources already spread thin, payers may not be able to provide the benefits and experience their specific members want.

Payers must develop flexible care management models that respond to specific member needs and leverage team-based care to deliver coordinated, high-quality RN interactions, including in the home. Offering technology to coordinate care may be appropriate for some members, but providing qualified staff, like registered nurses (RNs), to go into member homes and deliver personalized care, is also vital as the older population grows. Tapping into a network of RNs and having the ability to scale when needed will be the key to success as healthcare costs continue to rise and member experience becomes critical to consumer satisfaction and payer revenue.

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