Eight ways health plans can empower consumers

As "value" takes on growing importance for health plans and providers, these organizations must find new ways to improve care quality and reduce care costs.

One of the top ways to accomplish this is to get health plan members in on the action. If members become more engaged with their care, they will make smarter healthcare spending decisions, they will take advantage of the preventative services available to them, and they will take better care of themselves.

So how can plans and providers turn the dial up on member engagement? We asked three experts to share their top tips.

Encourage members to select a practice, not just a provider.

Members need to understand that they will benefit more from practices that deliver team-based care; and they need information about what team-based care is and why it's important-especially for members with chronic conditions.  

Health plans need to contract with practices, not just individual providers within practices, and provide information to members about the characteristics of the practice. Members should learn to select practices known for wellness care, not illness care.

Karen Handmaker, MPP, vice president of population health strategies for Phytel.

Provide advanced care planning support.

Assist plan participants with understanding and completion of advanced care planning, which is appropriate for all ages.

Leslie Faulk, RN, MBA, PMP, vice president of customer success for Health Catalyst.

 

Identify practices that are recognized as Patient-Centered Medical Homes (PCMHs).

Members need to know which practices are NCQA certified as Level 3 medical homes, what this means, and what services are offered in them, such as team-based care, health coaching, integrated behavioral health services, access outside of the practice walls and hours, use of health IT for proactive reminders, tools for managing chronic and preventive care, etc.

Karen Handmaker, MPP, vice president of population health strategies for Phytel.

Provide care managers and patient navigators.

Many health plans provide case managers, persons who are primarily focused on utilization. Patient navigators are the glue between the providers and the patients. The patient navigator understands patients’ needs, the patients’ social and physical environment, the care process physiology, evidence based interventions, and the healthcare system ecosystem.

Leslie Faulk, RN, MBA, PMP, vice president of customer success for Health Catalyst

Publish Triple Aim indicators of providers/practices in "narrow networks."

Members need to know way more than waiting times and whether a practice or provider is taking new patients, especially when their choices are limited.  Health plans have a vested interest in creating "high performing networks" that demonstrate the Triple Aim: lower cost, better quality and high patient/provider satisfaction. 

Karen Handmaker, MPP, vice president of population health strategies for Phytel.

Provide healthy lifestyle coaching.

Health plans need to increase customer engagement touchpoints to provide healthy lifestyle coaching. Often these services are available for premium customers who are part of an employer benefit program. The benefit needs to be extended to a larger population, especially those who are identified as “high risk.” The lack of clear ROI established for these programs makes it a seemingly expensive proposition for health plans, However, there are examples available today that show the value of preventative health coaching.

Anand Natampalli, vice president, global sales & business development, for HGS.

Publish prices that are easy to access and understand.

Members have a big stake in healthcare spending with ever-increasing deductibles.  Make it easy to see that preventive and wellness services are free/low cost even before deductible, as well as prices for visits, testing, ancillary services, etc. that must come from a member's deductible.

Karen Handmaker, MPP, vice president of population health strategies for Phytel.

Redesign benefit plans to align member, employer, provider, and practice incentives with the Triple Aim.

For example, provide incentives for members with diabetes to participate in "bundled" services that are delivered by a practice's PCMH care team that match up to a member's care plan and offer continuous support versus episodic care.  If members improve their numbers and avoid ER/hospital through better self-management, they would receive credit or some other benefit, just as practices/health systems get credit.

Karen Handmaker, MPP, vice president of population health strategies for Phytel.