According to an Accenture study, more than half of healthcare plan members who switch plans do so because they are dissatisfied with the experience they receive, such as inaccurate or inconsistent information, a poor digital experience, unsatisfactory customer service and discomfort with how payers use their personal data. A poor experience, in fact, drives more members to switch plans than unhappiness with benefits or coverage.
As healthcare consumers, many of us are all-too familiar with the kinds of negative experiences that cause us to consider finding a new healthcare plan. Irrelevant communications, such as receiving a reminder to schedule a colorectal screening that we’ve already taken care of. Untimely or lacking communications, such as spotty appointment reminders. Or even a disjoined website experience where it’s difficult to find the information we need. Our healthcare plans market to us consistently, but too often what comes through is a “collision of messages” and irrelevant communications that undermine member trust and satisfaction.
Break Through to Member-Centricity
Despite trying their best, healthcare plans find it challenging to meet the modern healthcare consumer’s expectations for a personalized, relevant experience. With data systems and infrastructure centered on employers, on a specific channel, or on a specific metric, what gets lost in the shuffle is the member. Because healthcare plans have not been incentivized to differentiate one member from another in terms of a member’s individual healthcare journey, preferences or behaviors, it is difficult to overcome the barriers that are caused by legacy infrastructure and data siloes to become member-centric. Challenges include:
- Difficulty identifying the right populations and activating them individually
- Orchestrating personalized programs in a coordinated way
- Measuring and optimizing member engagement at a strategic level
Consistent Experience, Greater Trust, Better Outcomes
As consumer choice and regulation have increased, it becomes mission-critical for health plans to adopt a member-centric approach and find new ways to engage and empower members to drive better health outcomes while they focus on cost optimization. The benefits in doing so include improved health outcomes from members who are more engaged, reduced costs through better care coordination and utilization, and higher member satisfaction and loyalty, leading to stronger growth and a lower risk of churn. In the Accenture report, plan members are 3X more trusting of a healthcare payer when the plan provides consistent and accurate information.
One healthcare plan discovered that the No. 1 barrier for women taking an at-home osteoporosis exam was the question of whether she had to dis-robe. By sending communications that address that specific point, the plan saw a 35 percent year-over-year increase in completed examinations. Another plan saw a 2X increase in diabetic screenings by personalizing outreach according to historical reasons for non-compliance by age cohort.
What does a member-centric approach look like in practice? Consider the colorectal cancer screening gap. Many plans market to an age group, sending a static message or reminder based on little more than a member’s birthdate. Family history, a member’s proclivity to schedule annual screenings, reasons for noncompliance and other factors are usually ignored. But what if, for example, a plan knew that one member had a history of delaying routine care because she was always pressed for time, while another member had previously put off the same screening because he didn’t like the prep work (or didn’t receive a reminder to complete it). Tailored messaging that addresses an individual member’s concerns and history is proven to produce better outcomes, i.e., more care gap closures. One plan, for example, discovered that the No. 1 barrier for women taking an at-home osteoporosis exam was the question of whether she had to dis-robe. By sending communications that address that specific point, the plan saw a 35 percent year-over-year increase in completed examinations. Another plan saw a 2X increase in diabetic screenings by personalizing outreach according to historical reasons for non-compliance by age cohort.
Actionable Insights Through a Deep Member Understanding
Achieving a level of member-centricity that moves the needle on better outcomes, lower cost and improved member satisfaction starts with data. That is, using data to derive a deep understanding of an individual plan member, to build meaningful segments and to deliver pitch-perfect communications that are in the context of a plan member’s healthcare journey. All communications are relevant to the member’s experience and are delivered at the right time and on the right channel. Furthermore, a deep understanding of an individual member unlocks new opportunities to build satisfaction and foster trust. A unified member profile that includes social determinants of health, for example, might indicate that a member is challenged with accessing nutritional foods. A plan might offer educational materials, or offer a discount on a food delivery service – providing a personalized experience while also yielding better outcomes.
To deliver a consistent experience that reflects a deep understanding of a member, a unified member profile should be available and accessible to the entire organization to ensure a single brand voice, a single set of decisions and single set of experiences across an omnichannel member journey. Beyond having a deep level of understanding of who the member is through their data, the other component of using it to enhance the member experience is to operationalize that data flow effectively across your technology stack.
A member-centric approach consists of three core capabilities:
- Profile unification and activation: Consolidating member data from various internal and external sources into a unified, accurate, and up-to-date profile (a Golden Record) that can be used to power personalized engagement. This includes using identity resolution to connect anonymous and known member data.
- Segmentation and Orchestration: Creating dynamic, intent-based member segments and orchestrating consistent, omnichannel experiences across all touchpoints. This requires high levels of automation to scale personalization efforts.
- Inbound, Synchronous Interactions: Updating member profiles in real-time to deliver personalized experiences during in-the-moment interactions on websites, portals and apps. This requires tight integration of data, context and decision-making.
By investing in these capabilities, health plans can break down silos, eliminate irrelevant communications, and deliver more meaningful, personalized engagement that drives improved outcomes and lower costs. The key is to start small, prove the value, and then scale these capabilities across the organization.
- For more on personalizing, harmonizing and optimizing engagement and outcomes through a member-centric approach, join Engagys Co-Founder and Managing Partner Kathleen Ellmore and Redpoint Global Chief Marketing and Strategy Officer John Nash in an on-demand webinar with a focus on how healthcare plans can knock down the barriers to personalized engagement.
- To see how you can start transitioning to a member-centric approach using your own data, Redpoint and Engagys are running a POC to help health plans accelerate on the path to member-centricity
