Integra Insights


Solving The Tough Ones

As we see fragmented healthcare and chaos everywhere, it is time we take responsibility for improving the system and finding our “disengaged” populations. There is no magic pill and no downhill path for this.

We must find, educate, connect, and impact every person so that the GNP trend of healthcare spending doesn’t continue to go up while quality of life and life expectancy decrease. Wellness should be simple and care plans should be clear.

Step 1: Identify your “disengaged” members. Ask for help from Integra, if needed.

Step 2: Identify those with high medical costs, outlier ER usage, frequent inpatient utilization, plus high cost with low RAF, and high prescription drug spend and low RAF.

Step 3: Review your care management programs and what they impact. Are the  members you found above in these programs?

Step 4: Analyze care and case management “activation and opt out rates.” Why is activation low and opt out rates high?

Step 5: Collaborate with Integra to redesign your engagement goals and objectives, plus your pathways to care, disease, and utilization management.

Step 6: Establish benchmarks to track performance and prevalence.

Step 7: Launch with a reframed intent- solving the tough problems and better supporting the disengaged population.