Posted by Prealize Health ● December 12, 2021

Eight Holiday Gift Ideas for Every Health Plan Executive

The end of the year represents a pivotal time for reflection and recalibration. For the health plan executive, part of that process should include considering how to improve member care in 2022. 


To help, we’ve assembled the top eight gift ideas for health plan executives. Broadly, these gifts will keep on giving and result in dramatic improvements for member outcomes and for your bottom line. 


The Gift List


#1. Identify more behavioral/mental health problems

gift idea - mental health - payer executive - prealize healthWith 90% of the nation’s $3.8 trillion in annual healthcare spend going to chronic mental health conditions, identifying these conditions earlier—and proactively intervening—has never been more important. The urgency has increased given the pandemic’s toll on mental and behavioral health. 


Hot gift idea: Predictive analytics, which can help by identifying at-risk members up to 12 months before a diagnosis hits the claim. Plans that partner with Prealize are already identifying 20%-25% more at-risk members pre-diagnosis and a 50% lift in digital campaign participation. With earlier identification, plans can connect members to the right program earlier and reduce the potential for costly ED visits. 


#2. Identify more prediabetics for early targeting

Untreated prediabetes often escalates to diabetes, and individuals with diabetes have medical expenditures approximately 2.3 times higher than those without the condition. 


Thoughtful gift idea: The ability to identify at-risk members sooner so plans can target those members for earlier intervention and outreach. Prealize’s partnership with plans is resulting in the identification of 10 times more prediabetic members found pre-diagnosis than through traditional methods. 


#3. Identify future high-cost claimants earlier 

While it’s critical for plans to identify members with pre-diabetes and behavioral health problems earlier, plans must also find ways to proactively intervene for numerous other conditions such as cardiovascular problems, musculoskeletal conditions, and obesity.


Unique gift idea: The capacity to match members to 35+ program categories, including high-cost, high-need areas, up to 12 months before diagnosis. In addition, Prealize is helping plans identify high-cost claimants 6-18 months prior to a likely event or procedure. 


#4. Decrease avoidable emergency department utilization 

About 30% of emergency department visits among patients with common chronic conditions are potentially unwarranted, leading to $8.3 billion in unnecessary costs. 


Recommended gift idea: Catching chronic health problems before they escalate into emergent conditions. Prealize does just this, helping plans engage more effectively with those members. That’s resulting in a 15% decrease in avoidable emergency department or inpatient utilization for plans that partner with Prealize.  


#5. Increase engagement of targeted members 

While predictions are key to earlier interventions, plans also need member-level insights about the most effective engagement strategies. 


Best gift idea combo: 

Sentara Health - white paper - gift for payer executive - prealize health
    • Curated member outreach lists based on rising risk, cost, drivers, and likelihood to engage, so that you can prioritize resources based on your overall strategic objectives.
    • Personalized engagement recommendations for high-risk members that complement care management expertise and are based on the member’s history and engagement preferences.

Prealize’s partnership with plans entails both, and leads to a 20% increase in member engagement compared to traditional methods. A recent case study featuring Sentara Health Plans found a 19% lift in engagement for Medicare and Medicaid members. 


#6. Decrease avoidable admissions and 30-day readmissions 

Evidence suggests that timely primary and preventive care can deter expensive hospital stays, especially among specific subpopulations. Plans need ways to identify and discourage preventable inpatient care.


Always-appreciated gift idea: Reducing avoidable admissions by 15% Plans that partner with Prealize experience that result, as well as a 10%-15% decrease in avoidable 30-day readmissions. 


#7. Decrease total cost of care

Earlier identification of high-risk members and more effective engagement can significantly decrease the cost of care for members. In addition to preventing avoidable emergency department use, admissions, and readmissions, earlier identification has other benefits. For example, plans can steer patients to Centers of Excellence earlier, which provide exceptional quality while reducing costs.


Gift idea for those on a budget: Engaging the right members sooner means $190 to $500 decrease in medical spend per engaged member per month. This impact can be felt across all lines of business as well. For example, Prealize’s partnership with Sentara Health Plans is resulting in 23% less spend for Medicaid and Medicare members. 


#8. Close more gaps in care

Gaps in care—such as delayed or missed cancer screenings—have a significant toll on member outcomes and costs. 


Optima Health - report - gifts for payer executive - prealize health

Gift idea for the exec who has everything: 

The ability to flag members most in need of screenings. Predictive analytics can close screening gaps by identifying members in need, and by helping care managers better engage them. Plans that partner with Prealize, such as Optima Health, are experiencing significant preventive screenings increases, such as a 5% increase in mammography rate and 5%-7% increase in colorectal cancer screening rate.


If you or a deserving health plan executive you know are interested in learning more about how Prealize can help your organization achieve these eight capabilities, reach out to us here. 


We wish you and yours a healthy and prosperous new year.