Care Management, Credit Scores, And The Future

I happen to pay less for auto insurance each month because I have a good credit score.

But that wasn’t by my design. I didn’t even know this was the case until I read some data from Consumer Reports. They estimate a $214 savings difference for those with a great credit score vs those with just a good credit score.

How does it work? The short and unscientific summary is that if your credit score is very high, you are considered more reliable in your financial payments and choices, thus signaling less risk for the auto insurance company.

This sort of thinking doesn’t stop with auto insurance.

Your health status may be assumed or predicted, at least in part, based on your credit score, so believe researchers at Duke University based on a study published in 2014.

The idea might seem a little far out there, sure. But this new kind of thinking mirrors how healthcare organizations, particularly payers, now think about care management — they are embracing new and different paradigms.

Care management has existed for years in some form or another, perhaps mostly as utilization management. The traditional cost-cutting and cost-containment mentality, however, is changing quickly as health plans explore and benefit from new risk-sharing partnerships with healthcare providers. This shift results in the patient being the primary focus.

With the patient at center stage, care management doesn’t just focus on the care encounter. Instead it takes into account the time and health needs before and after the care encounter. In some cases (hopefully more as we move into the future), care management doesn’t even relate to a particular incident or healthcare encounter.

After all, managing care is really more about pre-managing health needs and preventing illness than it is about filling a hospital bed. Or at least, it should be. That’s where healthcare organizations see the future, and that is also where they (almost always) see their current care management solutions falling short.

And solutions are falling really short. The gap between expectations and current functionality has become quickly apparent as KLAS has gathered and received feedback and experiences from health plans regarding their care management vendors.

Other go-forward focus areas and key paradigm changes in care management include increased integration and use of clinical (not just claims) data, greater provider/payer collaboration, automated patient/member communication, and individualized member engagement.

Considering where the industry is today, this new vision represents a lofty goal.

But in times past, so too was the idea that credit scores should one day impact your auto insurance rates, or that they could be considered an important correlating factor regarding your health status and/or health propensities.

Care management is in for a change. Get ready for the future.

[Joe Van De Graaff is a Research Director at KLAS Enterprises specializing in analytics. For more information about KLAS, click here. To follow KLAS on Twitter, click here.]