Authors: Shreekanta Kumar Sahu, Sr. Consultant, CitiusTech and Dr. Vishal Anand, Sr Business Healthcare Analyst, CitiusTech
To stay competitive, “payvider” health plans are under uniquely stringent pressures to control costs and improve member outcomes. At the same time, rising healthcare consumerism is making members increasingly active in their healthcare journeys. The right approach to member engagement can leverage this convergence to inspire members to proactively take control of their health and wellness—thereby enhancing health outcomes and reducing costs.
Members expect their payviders to provide a seamless, comprehensive, and personalized experience that spans the membership lifecycle. Fortunately, technological advancements such as affordable high-speed internet, mobile devices, and the Internet of Medical Things (IoMT) make it easier for payviders to engage with their members in more meaningful ways. However, payviders must use various analytical tools to understand their members’ areas of satisfaction and their challenges on the end-to-end healthcare journey.
Analytics can help identify the challenges members face in different areas across the value chain, and pinpoint the associated bottlenecks that could lead to dissatisfaction. With this insight, payviders can create better, more personalized digital touchpoints to enhance member engagement. Some of the digital touchpoints that could be addressed include
- Plan selection/enrollment: Artificial intelligence/machine learning (AI/ML) and analytics platforms can be used to help members select and personalize their benefit plans. Once members choose a plan, the next step is to help them seamlessly enroll themselves and their dependents. Members should also be able to view and make premium payments digitally.
- Member contact center: Payviders can enable virtual digital agents (e.g., chatbots, virtual agents) to answer questions and make it easier for members to resolve any issues.
- Telehealth and wellness initiatives: Payviders that invest in telehealth services and wellness initiatives (like monitoring health with fitness tracking data) can better engage members through various fitness or wellness challenges and competitions.
- Cost and benefits transparency: CMS-regulated health plans are required to provide cost transparency tools to members to allow them to verify cost, benefits, eligibility, and alternative services.
- Community and social networking: Sharing health-related content on social platforms is another way payviders can engage members
Through integrated mobile apps, payviders can encourage members to participate in health and wellness programs. They can also enable members to access data and services anytime, anywhere. For example, through an integrated member portal, members can connect to all the self-service tools they need in a single place.
Payviders empower members to become engaged and informed participants in their care experience by giving them the tools they need to enroll in a health plan, get the provider and benefits information they want, and receive the care they need. Such insightful engagement can help drive better clinical and financial outcomes for all.