Health plans that rely primarily on claims data and utilization patterns to inform their risk models will find themselves in unchartered waters in 2021. Pandemic-related disruption to care delivery will distort traditional risk models and create uncertainty around care costs, risk-adjustment payments, health outcomes, and the effectiveness of engagement strategies. To secure Star Ratings, improve care compliance, close gaps, enhance member satisfaction, reduce costs and drive profitability, health plans will need to incorporate new sources of data and create a more robust and nuanced understanding of plan members.
This white paper examines how disruptions in care utilization will have a cascading effect on health outcomes and financial performance in 2021 and beyond. We’ll share risk model and patient engagement strategies to help health plans meet ballooning care needs and prevent unexpected financial losses.