New Medecision Research Reveals Top Barriers Holding Health Plans Back from Reducing Costs

Market report shows that health plan executives are at a critical turning point, and optimistic about AI – but are they ready for transformation?

Medecision, the leading clinical data and analytics platform company, has announced the release of its comprehensive research report, “The State of Utilization Management, Care Management, and Population Health in 2024.” This in-depth study provides critical insights into the current landscape and future trends in health plan strategies and technologies.

The research highlights the challenges health plan leaders face and unveils surprising findings, notably the gap between executives’ recognizing the importance of personalization and the current state of implementation.

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Other key insights include:

• 95% of respondents say it is “moderately important” or “very important” to incorporate personalization into care management — but only 34% rate their health plan as being “very personalized.”
  
  
• 68% say inefficient workflows are their top frustration with current tools. Top barriers include: lack of member engagement tools, and lack of ability to react in real-time.
  
  
• 51% of respondents say AI and machine learning would be “very impactful” in optimizing workflows to increase member engagement and health outcomes.
  
  
• 77% indicated that it is very important to see all touch points for high-risk members and 60% say it is very important for rising-risk members.
  
  
• 63% of responses found great value in care management and coordination tools to help comply with existing and future regulations.

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The research calls for a fundamental transformation, emphasizing the need to harness broader data sets, cutting-edge technologies, and innovative strategies to enhance efficiency and value in UM, CM, and engagement capabilities. Strategic data use, AI, and automation are essential for managing utilization effectively and achieving the necessary personalization to sustain member engagement, reduce costs, and improve health outcomes.

“The insights from our research reveal that health plan leaders are at a turning point, grappling with outdated tech and fragmented data. At Medecision, we’re making data their strongest ally,” said Kenneth Young, president and CEO. “Our response is to empower them with advanced, user-friendly technology that effortlessly processes real-time data in its raw form, tailored for care and utilization management. This innovation not only simplifies decision-making but also amplifies operational efficiency, member engagement, and improved outcomes, all while driving down costs.”

“The State of Utilization Management, Care Management and Population Health in 2024” is based on independent research conducted by healthcare consultancy Sage Growth Partners. The survey included 53 leadership respondents representing a range of functions including care management, care coordination, utilization management, and operations.

“Our research shows that health plans can establish better contextual awareness through the integration of a wider variety of data types — whether medical, social, or behavioral — to create a 360-degree view of individual members,” said Stephanie Kovalick, Chief Strategy Officer, Sage Growth Partners. “It is vital for health plans to implement new technology and leading-edge tools to help improve outcomes for members, prevent unnecessary hospitalizations, and reduce avoidable high-risk events.”

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