Consumerism's rise remodels methods of care management

A more consumer-centric approach to healthcare has caused health plans to forgo the communications strategies of old. Consumer-directed benefit products such as health-savings accounts (HSAs) have caused consumers to shoulder more responsibility in making healthcare choices to make their dollars go farther and to weigh carefully the cost, quality and necessity of the care they purchase.

"What they [the financial industry] have realized is that there is a great benefit in knowing who your customers and prospective customers are," Glebe says. "They want to make sure that whatever message they're trying to deliver to you, whatever action they're asking you to take, is as tailored as can be to the person you are-that it's going to have the highest likelihood of having an impact on your behavior."

A TAILORED APPROACH

For instance, although plans may spend tremendous amounts of money on programs such as disease management (DM) or care management, the programs' communications tend to treat individuals in a population-such as diabetes patients-as one in the same in terms of the message delivered and how it's delivered. This causes plans or DM programs to miss a chance to save costs and to encourage patients to modify behavior, such as complying with their treatment regimens, according to Glebe. Care managers could take a page from the best practices of the financial services industry, which targets certain customers who have particular interests with credit cards that build toward rewards or services that would interest the customer, he says.

"They proved that knowing your customer along with designing a tailored approach, has the greatest impact on individual behavior," Glebe says.

Tailoring an intelligent member communication approach that addresses a diabetic population would include providing ways to simplify the process for a busy single mother whose children take priority over her insulin treatments; for someone who is going through financial difficulties, information about community resources that can assist with payments would be provided.

Other steps would be to point out information about generic products, mail-order or samples available and assist in the necessary administrative tasks to fill a mail-order prescription, all focused toward the goal of decreasing program costs and heightening return on investment.

"With an increasingly crowded marketplace, the ability to leverage consumer insights to tailor care management interactions will be the critical factor is separating the companies that will succeed from those that will fail," Glebe says.

Effective data gathering-the basis for predictive modeling or the segmentation of populations into targeted behaviors such as smoking-provides a foundation for putting a face on those consumers. However, using predictive modeling and segmenting populations are minor steps toward a greater knowledge of the customer for the healthcare industry, Glebe says.

"Nearly all of the identification that happens today is based upon a very narrow view of the individual, comprised almost entirely of healthcare claims data," he says.

LIFESTYLE INCLUDED

Health plans and care management companies have been incorporating some information about an individual's lifestyle, demographics and attitude available to and used by other industries as a step toward a more meaningful, rounded view of that person, but the expense involved and the general insights provided by the segmentation data provide little guidance in correlating interactions with individuals, Glebe says.