14 Ways Insurers Can Improve Patient Experiences

August 12, 2019

Experts provide 14 ways that insurers can improve their members’ experiences with them.

The healthcare industry is slowly starting to implement the type of consumer engagement best practices that have been hallmarks in the retail, travel, and financial industries for years: listening to individuals and designing personalized solutions to incentivize outcomes.“With the growth of consumerism and a shift to value-based care, plans today recognize that connecting with consumers is imperative to ensure the health of both their plan and their members,” says Tom Wicka, chief executive officer of NovuHealth, a healthcare consumer engagement company in Minneapolis.Consumer engagement in healthcare keeps individuals on top of their own well-being, leading to healthier outcomes. On the flip side, non-engaged consumers are often high-cost consumers, because they bypass early prevention and detection and don’t properly manage chronic conditions.“It’s incumbent upon plans to take a proactive approach to engage consumers and improve their health, which results in other benefits such as lower healthcare costs, compensation from stronger outcomes, and improved plan performance,” Wicka says.Here, experts provide 14 ways that insurers can improve their members’ experiences with them.

“Claims and clinical data only provide a sliver of insight into what has historically occurred within a population,” says April Gill, vice president of market solutions at Welltok, a software as a service company for consumer health. “Broaden your understanding of your members by layering in broader data sources and advanced analytics.”

The most predictive data about someone comes from outside of healthcare-such as a member’s level of education or where they live. “These elements provide a deeper understanding of an individual’s likelihood to respond to various communication channels and to take action,” Gill says. Use consumer data from non-healthcare sources such as census, financial, and commerce to easily predict and respond to an individual’s change in health status.

Don’t rely on one type of communication method. By working with a qualified vendor to securely collect and predict a member’s channel preference, organizations can drive cost-effective engagement outcomes by delivering the right message, to the right person, at the right time. “An outreach strategy that encompasses a variety of communication channels can provide cost-effective ways to engage and activate consumers,” Gill says. For example, aligning with a member’s preference to receive text messages can improve the chances they will take action.

Some members will only respond to an email, but for short messages with a regular cadence, texts are a great choice. “And although we live in a digital age, automated voice still works best for some individuals,” Gill says.

When sending every member the same content, a message has to be general enough to apply to everyone. But that means that it won’t feel personal to anyone. “Consumers want the same thing from their health plan that they want from every brand or service they engage with; they want to be uniquely seen and understood,” Wicka says.

“Plans should consider setting up triggers around key activities, such as when a member needs to complete a specific activity and distribute that message automatically to create a more personal member experience,” Wicka adds.

Make educational materials and benefit explanations as readable, accessible, and as easy to understand as possible. “Just because healthcare is more complex than ever, doesn’t mean that your member communications need to be as well,” says Jennifer Truscott, senior vice president of operations at EmblemHealth in New York, New York. “Communicating simply is one of the most critical ways to build trust with members and help them understand your value.”

EmblemHealth’s “Speak Human” campaign represents its commitment to engage with members and partners in a simple and clear way. “We make it a priority to use plain, direct language, and have extensively reviewed and refined all of communications materials,” Truscott says.

A call center is typically the front line for a member’s engagement with their health insurer and defines a member’s broader experience with their health plan. “It’s crucial that individuals answering members’ calls serve as true company ambassadors who can resolve issues,” Truscott says. For insurers, this means emphasizing soft skill training, prioritizing long-tenured representatives, and integrating clinical resources directly into the call center.

Websites and online portals should allow seamless access to a broad range of resources, like plan details, benefits information, and physician locations. Trustcott adds that wellness tools can enhance a member’s experience and encourage a healthier lifestyle.

Members expect convenient service through technology. In 2018, 57% of Blue Shield of California member interactions occurred on its digital self-help platforms. “We will continue to expand these convenient options to delight our members even more,” says Michael Bassett, MBA, vice president, Customer Experience Operations and Shared Services at Blue Shield of California in San Francisco. “But it’s not enough to be high-tech. We have to be high-touch as well, which means serving our members as whole people. One way we have done this is by removing the ‘average handle time’ guidelines for our call center staff. They are now able to spend as much time as needed with each member who calls in.”

One way to do personalize care is to develop new, innovative health plans that foster and incentivize new approaches to care delivery. A flexible health plan is one that is smart enough to see the trend moving toward self-care, wherein the delivery of care services happens more often at home, with patients administering care under the guidance of licensed providers. “To personalize care, payers may need to act as consultants, revealing options to patients that they may not know exist, such as virtual care, while also providing patients with the coverage they need to pay for such innovations,” says Donna Martin, senior vice president, Global Healthcare, HGS, which provides business process management services.

In order to help members navigate the administrative aspect of healthcare, EmblemHealth offers one-on-one, in-person help at its EmblemHealth Neighborhood Care centers, ConnectiCare centers, and AdvantageCare Physicians’ offices. These centers support individual health and wellness journeys through programming and classes that champion multiple dimensions of health including physical, financial, intellectual, social, and emotional aspects. “We bring resources directly to members in the communities they live via knowledgeable individuals and useful educational resources,” Truscott says.

Visitors to Neighborhood Care centers and ConnectiCare centers interact face-to-face with staff to get answers for their member-specific inquiries.

Up to 80% of a person’s health is attributable to social, physical, and behavioral factors. “In order to improve our members’ experiences, it’s critical that we go beyond healthcare to help them,” says Rhonda Mims, executive vice president and chief public affairs officer, WellCare Health Plans, Inc., Tampa.

For example, WellCare’s Community Connections Help Line is staffed by a team of peer coaches. “This means that they have experienced trying times or crises, such as disability, caregiving, or even homelessness, and can offer peer-level support and connections to resources,” Mims says. The sole purpose is to connect callers with services in their community that help them with services beyond healthcare, from help paying utility bills to assistance in finding affordable housing.

Blue Shield of California provides personalized tools and services that empower its members to have a better quality of life. The tools also help the insurer better understand what’s important to each member so they can look out for their best interests; advocate for members’ wellness and support them; and create an emotional connection with members so they choose the insurer for life, Bassett says.

Blue Shield of California also trains and deploys health advocates directly into communities where members live. These professionals provide personalized, in-home, high-touch care, integrated with innovative technology. “This goes beyond simply insuring our members; it creates a true, trusted partnership,” Bassett says.

Research shows that a lack of predictability is among members’ biggest frustrations with health insurance. “Health insurers should use their role in financing care to help consumers anticipate expenses, plan for expenses, and be prepared to cover them,” says Jeff Gourdji, partner, Healthcare Practice Leader, Prophet, a growth and digital transformation firm. When members look for the cost of a procedure or treatment on a website, they shouldn’t receive vague, unhelpful responses such as, “you may be covered for x” or “the cost may be in the range of x to x.” Insurers should provide members with concrete information regarding costs.

Because health systems are fragmented, they’re filled with inefficiencies that inconvenience consumers, says Benjamin Isgur, health research institute leader, PwC, which analyzes trends affecting health-related industries. For example, consumers oftentimes have to fill out similar forms repeatedly. Or, when questions can’t be easily answered on an insurer’s website, members have to go through a multi-step call bank, which is difficult to navigate. Insurers should look for easy ways to streamline operations and ease these frustrations.

WellCare does this by creating value-based arrangements with providers and cultivating relationships with advanced practices. Currently, 55% of its Medicare payments and 34% of Medicaid payments align to value-based type of arrangements.

Many of its members, particularly those on Medicaid, rely on places such as public hospital systems or Federally Qualified Health Centers as their regular source of care. “WellCare works with these providers regardless of where they are on the value-based spectrum, with a special focus on safety net providers,” says Kelly Munson, executive vice president, Medicaid, WellCare.

This includes streamlining operations to avoid duplicative services and encouraging providers to drive high quality, cost-effective care. “Align incentives to help providers focus on keeping patients healthy and better manage complex conditions,” says Debbie Zimmerman, MD, corporate chief medical officer, Lumeris and Essence Healthcare, a value-based managed services partner headquartered in Maryland Heights, Missouri.

One way to do this is to include balanced metrics in provider contracts that focus on quality, cost, and access to support improving population health. In addition, incorporate provider input into bid development when designing plans to ensure patient needs are met in the plan’s benefit design. Share information with providers to identify improvement opportunities.

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