KING OF PRUSSIA, PA — May 21, 2025 — A new report from Medecision, Building the Intelligent Health Plan, reveals a clear message from health plan leaders: current digital care management (DCM) tools are not meeting the moment. As financial pressure intensifies and members’ needs become more complex, the report offers a candid look at what’s working, what’s not, and where plans must go next.
Based on a national survey of fifty health plan executives conducted by healthcare consultancy Sage Growth Partners, the report identifies key disconnects in how payers are trying to deliver more personalized, data-driven care management at scale—but are held back by outdated systems and manual processes.
Key findings include:
- Only 8% of leaders say their DCM tools can act in real time
- Fifty-two percent report their tools are failing to engage members effectively
- While 98% aim to personalize outreach, just 10% can do so today
- Sixty-five percent say seamless data integration is critical—yet only 17% say their platforms deliver 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.”
While the findings underscore industry frustration, they also highlight optimism. Leaders agree the next generation of DCM solutions must go beyond case tracking to support real-time data, 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 purpose-built to meet these needs. Designed to integrate with existing workflows or replace legacy systems, the solution enables:
- Real-time outreach and proactive interventions
- Scalable member engagement without increasing staff
- Intelligent workflows powered by data from across the ecosystem
“Plans don’t need more dashboards—they need systems that make data usable, timely, and actionable,” added Young. “That’s where we come in.”
Download the full report and explore how your organization compares—and what steps to take next.
About Medecision
Medecision delivers data event-powered solutions that enable risk-bearing organizations to manage care management, utilization management, and population health efficiently and intelligently. Trusted by organizations covering more than 10% of the U.S. population, the Medecision platform provides real-time insights, automation and intelligence, seamless interoperability, and scalable engagement to help customers improve outcomes while reducing cost and complexity. Learn more at https://hubs.la/Q03ncBNr0.
About Sage Growth Partners
Sage Growth Partners is a healthcare advisory firm with deep expertise in market research, strategy, and communications. Founded in 2005, the company’s extensive domain experience ensures that healthcare organizations thrive amid the complexities of a rapidly changing marketplace. Sage Growth Partners serves clients across the full healthcare spectrum. For more information, visit https://sage-growth.com/.
Media Contact:
John Gonda
JGonda@sage-growth.com
616.309.4888
About The Author: Clara McLouth
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