How Payers Can Align with Members on Consumer Engagement

Based on several reports in the last couple of years, it’s been a standout that healthcare consumers’ engagement in their own healthcare will drive better outcomes and reduce care costs. With that being said, consumer experience has come under major focus across the industry as a key business driver.

The industry has long been structured to separate the payers from care providers, and that leads to a misalignment of interests, with the consumer’s interests not put front and center, according to Mark Nathan, CEO of Zipari. A health plan’s primary objective should be to help consumers get the best care at the lowest price, Nathan added.

Through the ACA and the growth in Medicare Advantage, health plans started interacting more with consumers by necessity. Further shifts based on value-based care and integrated systems, have also narrowed the distance between payers and consumers, he said.

“Several recent industry studies polling payers have put consumer experience (CX) as either the first or second highest priority for payer IT spend,” Nathan said. “This is not surprising because (CX) data illustrates that when payers build positive relationships with their consumer, they not only influence more positive health outcomes, but they can also reduce costs for their members. The biggest related shift we are experiencing at payers is their expansion of their CX focus into the commercial segment and the positive value that CX can bring to employer populations.”

Consumer engagement in healthcare is every point of communication between the consumer and the payer or provider. For example, these include the Member Portal, Mobile App, Member Service Center, IVR systems, Care and Disease Management, chat bots, email, text, and paper.

Nathan said improving consumer engagement refers to making each of these forms of touchpoints a better and more meaningful experience for consumers. The best way to make the experience better is to provide the consumer with targeted and personalized advice that is of value to the member. If a consumer sees clear value in the communication, they will be open to additional communications that can further improve their experience.

The most valuable advice a payer would provide is an opportunity for the member to either improve their health or reduce their personal healthcare expenses. This can be advice to close specific gaps in care, get recommended screenings, adjust medication, or utilize more of the benefits a plan provides their members, he said.

“In the latter case, health plans are continually adding new benefits like behavioral health apps, loneliness programs, digital therapeutics, wellness programs and many more benefits that are included in the members coverage,” he said. “However, because consumers are not fully engaged with their plan, they often don’t know about these benefits, and hence the benefits become under-utilized. Better CX closes gaps, drives program registration, and increases benefit utilization.”

Though there may be common obstacles in adopting a consumer experience-focused plan of care, they can be conquered.

Nathan said one of the biggest challenges that payers confront when working towards improving the consumer experience is prioritizing the goals for their members. There are over 1,000 different typical goals that a health plan might have for their member from getting a specific screening, to closing a specific care gap, to registering in a care management programs to utilizing a new benefit. He recommends payers start with a few dozen goals and roll those out through modern consumer engagement tools, and then expand on that base.

“Consumer Engagement in healthcare is unlike any other industry, and the complexity of healthcare makes it difficult to utilize general purpose CX tools,” he said. “The payers that embrace the concepts of CX from other industries, but partners with experts that understand healthcare will yield the best results. At the end of the day, payers need to know what next best actions are most beneficial to improve a specific members health or reduce their cost, and then build a relationship with the member where they can make recommendations that the member heeds.”

“When a payer solves this equation, they will be on a journey to improve their customer satisfaction by continually improving member health and reducing the cost of care for all parties involved.”