KING OF PRUSSIA, PA — A new report released by Medecision reveals that current digital care management (DCM) tools are falling short in meeting the demands of health plans as financial pressures grow and member needs become increasingly complex. Based on a national survey of 50 health plan executives conducted by Sage Growth Partners, the findings underscore significant gaps between industry goals and the capabilities of existing systems.
According to the report, only 8% of health leaders believe their tools enable real-time action, and 52% find their platforms ineffective at engaging members. While 98% of respondents aim to deliver personalized member outreach, only 10% report being able to achieve it. Additionally, while 65% of leaders deem seamless data integration critical, a mere 17% say their platforms are capable of delivering it.
“This report is a must-read for health plan leaders evaluating their care management strategy,” said Kenneth Young, president and CEO of Medecision. “It’s clear that while the goals are well-defined—improved outcomes, optimized costs, better member experiences—the tools in use today often can’t deliver. The right infrastructure and intelligent technology are essential to close that gap.”
Despite these frustrations, the findings also signal an optimistic outlook for the future of DCM tools. Leaders broadly agree that innovation is critical to overcome current challenges, emphasizing the need for solutions featuring real-time data capabilities, AI-driven decision-making, and scalable personalization.
“Health plans recognize the need to modernize—but they need solutions that are built for the complexity and urgency of today’s care environment,” said Dan D’Orazio, CEO of Sage Growth Partners. “This research underscores the opportunity for plans to rethink their digital strategy and invest in capabilities that truly deliver value.”
Medecision’s Care Management with Co-Pilot is designed to address many of these issues. The solution integrates with existing workflows or replaces legacy systems, enabling real-time outreach, proactive member interventions, and enhanced scalability without staffing increases. It also leverages intelligent workflows powered by data across the ecosystem, making it possible for health plans to move beyond mere case tracking to actionable, timely insights.
“Plans don’t need more dashboards—they need systems that make data usable, timely, and actionable,” added Young.
For health plan leaders, the report serves as both a candid assessment of current limitations and a roadmap for achieving better outcomes with modernized, purpose-built tools. The race to adopt next-gen solutions is crucial as markets demand higher efficiencies and greater member satisfaction in an increasingly complex care landscape.
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