Day zero data: Getting pre-enrollment insights into new member health

Each year, nearly one-third of U.S. consumers switch their health insurance plans. This level of turnover creates challenges for health plans arranging to the delivery of cost-effective and medically necessary coordinated care. That's because when members enroll in a new plan, payers often lack timely access to their complete medical history. This is is due to inaccurate coding and members not having an office visit for months (or longer).

In fact, a transitioning member’s first in-network visit often can take up to three months or longer. Moreover, a study showed disruptions in care continuity like those caused by insurance transitions were associated with a roughly 12% increase in 30-day hospital readmissions.

Offering the best care to a new member hinges on having access to their accurate health information. Instead of waiting until their first visit and claims come around, what if you could get a head start by accessing their historical lab data—all before their first interaction with their new health plan begins?

The answer? Better, more coordinated and personalized care—and higher member satisfaction.

The negative effect on members with chronic conditions

This delay can be particularly problematic for individuals with chronic conditions. The CDC reports approximately 60% of U.S. adults have at least one chronic disease, with nearly 40% having two or more. 

Early intervention is critical to managing these conditions effectively, improving the quality of life, and preventing costly complications. Quickly obtaining health information on new members is critical for efficient and effective care coordination, reducing avoidable hospitalizations among high-risk populations, improving outcomes and lowering costs.

Health data is abundant, but too often untapped. In a system striving for personalized, value-based care, that missed opportunity can delay meaningful support for new members.

So what if plans could start a new member’s journey with a foundation already in place?

A theoretical tale of two new members

Meet James and Julian. Two 66-year-olds newly enrolled in a health plan, both living with chronic kidney disease and pre-diabetes.

While their ages and conditions are identical, the care approach from their health plans differs.

The role of pre-enrollment data

Access to historical health data, such as lab results, can help health plans identify chronic conditions earlier, understand disease progression/status and coordinate care effectively. Having access to a member's lab history at the start of coverage can enable earlier outreach and targeted education.

According to a Centers for Medicare & Medicaid Services analysis, care coordination around chronic conditions was associated with nearly a 5 % reduction in hospitalizations and a 2.3 % decrease in emergency department (ED) visits over two years.

How Julian’s plan reduces his risk of hospitalization and ED visit

In contrast to James’ plan, Julian’s plan and its outreach efforts begin the minute his eligibility file is received. Care coordination is initiated by using historical lab data to determine what gaps in care he may have due to his existing kidney disease and diabetes. 

Before his first office visit, they’ve already identified those gaps and engaged him via text or email to get them closed through a visit to a patient service center or by receiving an at-home A1c and KED test kit.

• Early access to lab data can benefit multiple stakeholders:
• Members receive more timely, tailored support, potentially improving quality of life and reducing costs
• Providers make more informed decisions with a clearer understanding of patient history, also avoiding unnecessary or duplicative testing, or other services
• Health plans may see improved financial performance and member retention, as well as better alignment with value-based care goals

Accessing Labcorp approaches and tools to make a broader impact

Advanced visibility into lab-based member analytics can help plans develop a baseline clinical view well before it’s needed. Labcorp Insight Analytics® provides comprehensive data insights and analytics to identify high- and at-risk patients, manage chronic conditions, and improve care coordination. 

By accessing our over 45 billion lab results and data from more than 150 million patients, representing approximately half of the U.S. population, stakeholders can gain a comprehensive understanding of patient health histories and risk factors. This helps payers and providers identify trends, pinpoint and stratify at-risk populations, and develop targeted intervention strategies.

As members, whether established or new, meet with their providers, Labcorp's Diagnostic Assistant™, a point-of-care clinical decision support tool, surfaces relevant lab insights. It gives providers real-time clinical decision support, helping them make informed decisions faster based on the latest evidence-based guidelines and patient-specific data.

By working with Labcorp and accessing these tools, providers and payers gain a longitudinal view of Julian’s lab history before his coverage even begins. This means earlier outreach, better coordination and proactive education from the start. 

For your outreach efforts, you can direct your members to our over 2,200 patient service centers reaching 95% of the U.S. population, as well as our mobile collection services and at-home test collection kits to conveniently meet your new members where they are.