Closing the Health Equity Gap: Reducing Claims Costs by 40%
By using an approach designed to build trust through shared identity, Reema was able to increase engagement, reach the unreachable, and ultimately overcome barriers to care, which led to significant claims cost savings when compared to the health plan’s control group.
Increasing engagement in any population is difficult, but engaging a population that a health plan has not been able to reach and have identified as “unreachable” is a unique challenge that requires a different approach.
The health plan partnered with Reema to engage their members who were diverse, dual eligible and unable to engage on their own. Together, we identified the following goals for the program:
- Increase engagement with previously hard-to-reach members
- Close social determinant gaps
- Enroll these newly engaged members into additional health plan programs
- Reduce overall healthcare costs for these newly engaged members
We anticipated that a reduction in healthcare costs would follow as a result of the new engagement and removing barriers to care because when people are engaged with their health and have the tools they need, they are more empowered and equipped to manage it.”
Reema’s first step was to understand the members the health plan wanted us to engage, then determine how our Community Guide team would work with these members. The member population was a group of highly diverse, dual eligible members with over 85% of members being people of color. The initial lack of engagement reported by the health plan pointed to a health equity issue and signaled a lack of trust between the members and their health plan.
This is something Reema does well. Shared identity is an important component of engaging the unengaged, and a core theme of our engagement approach. We’ve found that a lack of trust is the foundation for disengagement, so introducing an engagement model built on shared identity helps us establish meaningful relationships with members. And, over time, higher rates of engagement with health plan programs is achieved as trust increases.
Reema’s approach transforms how people navigate the gaps between health care and social care through technology and Guides from the communities we serve. This harkens back to the power of shared identity to make meaningful connections with members that lead to improved health outcomes.
Using our advanced technology platform, we are able to predict and identify the needs of members. Through a multi-channel approach—from text messaging to phone calls to home visits—we’re able to build trust with members by meeting them where they are, with communications they are mostly likely to respond to. Personalization is central to building meaningful member connections and consistent engagement.
A Note on Control Groups
It’s one thing to report results, but another entirely to do a side-by-side comparison to the health plan control group to demonstrate the true impact. The population consisted of 3,000 dual eligible members with 24 months of eligibility—12 months without Reema’s program, and 12 months with Reema’s program. And, the control group was consistent across the two years.
When comparing Reema’s intervention to the control group, we found we were able to reduce costs across the board—from overall claims, in-patient hospitalizations, emergency department visits, and long-term care. This led to significant claims savings and member retention, as noted in the program results.
Over the course of a year, our Community Guides engaged this population. From our own data and program results, we knew the engagement and cost savings were going to be significant. In support of this, our client’s healthcare economics team ran their own analysis to determine the overall impact of Reema’s program.
Twelve months after hiring Reema, the plan’s overall claims were down 40% compared to the previous twelve months, resulting in better than a 4:1 ROI. Further, Reema achieved significant total cost of care reductions including:
- 53% reduction in inpatient hospitalizations
- 22% reduction in emergency department visits
- 61% reduction in long-term care costs
These results serve as a major incentive for the health plan to prioritize bridging the gap between social care and healthcare because the value is significant.