Estimates show that 64% of the Medicare population and 72% of commercial and Medicaid plans have at least one care gap. We know that care gap reductions can lead to improved health outcomes and increased patient satisfaction, which can, in turn, improve quality measures.
Implementation of health management programs is helping health plans improve scores in the prevention, chronic condition management, and patient satisfaction categories, but overall improvement is highly dependent on engaged and satisfied members.
While there are two primary goals of disease management programs—to educate and inform and to motivate behavior change—the traditional model focuses more on the former and less on the latter.
If motivation and behavior rarely become the focus of systematic intervention, then it will be difficult for members to do their part in closing their own care gaps. What results is what we often see—a less meaningful impact on members’ health, healthcare utilization, and healthcare cost reduction.
If health outcomes are going to improve, members need help with changing behaviors.