How One Major Health Plan Is Tackling Care Manager Efficiency

Healthwise Communications Team

The number of people diagnosed with chronic diseases grows each year: A shocking 45% of all Americans have at least one long-term condition that requires self-management or ongoing treatment, but they only receive about half of the preventative health care services recommended for their condition.1,2 This means care managers’ jobs are harder—and more important—than ever.


Unfortunately, care managers often find that several aspects of their organization’s system work against them, such as fragmented workflows or a lack of standardization. When your team members find themselves trapped inside information silos or they must waste valuable time hunting down the information they need, everyone pays. The company’s costs go through the roof, care managers become frustrated, and members’ health outcomes take a nosedive.

It doesn’t have to be this way.

Tackling Care Manager Efficiency and Member Outcomes

One major West Coast health plan implemented two goals that worked together to improve efficiency and outcomes:

  1. Streamline operations to save money and reach more members.
  2. Find inventive ways to educate and communicate with members to encourage self-management of chronic health conditions.

To increase efficiency, the organization used an application called Healthwise® Coach, a database of health education resources and helpful reference sheets. Care managers used the content during calls, mailed it to members, or emailed it as a follow-up after appointments. The health plan then surveyed the coaching team to measure whether the application helped coaches do their jobs. They also looked at how its use impacted members.

Survey Says…

The responses showed that care managers were more efficient when they used the application, and they felt it helped them communicate with members.

Here’s what the care management team had to say about the coaching application:

  • 78% said it made their member interactions more effective.
  • 85% said it had the content their members needed.
  • 90% said it improved communication and the sharing of knowledge.

Apparently, patients felt the same way. Members who received content or information from the coaching app were more likely to follow up with outpatient providers, and they scheduled 1.2 more professional visits in a three-month period.

Empowered Care Managers + Engaged Patients = Success

The benefits of self-management education programs for chronic conditions continue to be proven as more studies tackle the subject and document their findings. For instance, UCLA Health recently conducted a study outlining how shared decision making tools can encourage people with prediabetes to take part in a diabetes prevention program and self-manage their condition better.3 Another, published in the Journal of Medical Internet Research, showed that patients who received and understood the information needed to make appropriate health decisions—the core tenets of health literacy—are less likely to be hospitalized or visit the emergency room.4

Every time a care manager interacts with a member, they have the opportunity to improve someone’s quality of life—or perhaps even save a life. But they can’t do this to their full potential without tools that put valuable education resources at their fingertips. Your members who have chronic conditions need information they can understand and act on. You can help them navigate the overwhelming maze of health education. Taking a page out of one major West Coast health plan’s playbook, you can break down barriers for your care managers so they can do what they do best: Help people.

4Greene JC, et al. (2019). Reduced hospitalizations, emergency room visits, and costs associated with a web-based health literacy, aligned-incentive intervention: Mixed methods study. Journal of Medical Internet Research, 21(10): e14772.