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Three ways health plans, providers can enhance member relationships


The success of any value-based care model depends on achieving a strong relationship with members. Here’s three ways how.

The healthcare industry has discussed the concept of pay-for-performance for more than 20 years. More recently, health organizations including Anthem Blue Cross and UnitedHealthcare have invested heavily in so-called “bundled” or “value-based” payment programs.

The idea, of course, is to move away from paying providers for the sheer volume of services they deliver. Instead, the goal is to structure payments around improving members’ overall care costs, quality and outcomes-putting both health plans and providers at risk. Consequently, many contracts now involve value-based programs designed to better coordinate care, manage chronic conditions, or address social determinants of health.  

Yet even the strongest value-based care contracts often overlook a simple truth: No program will improve outcomes unless it fully engages members.

Outcomes don’t improve just because providers make changes. Outcomes improve when members are more invested in their health. That doesn’t happen because of changes in payment models, either. Rather, it happens because of good relationships between members, providers and health plans.

So, at the core, the success of any value-based care model depends on achieving strong, dynamic member relationships.

Simplify member communication

The tools to engage members-including portals and personal health records-have steadily evolved over the years. Today, for instance, providers increasingly send people home with wearable monitoring devices that send data back to their practices, and 58% of smartphone users have downloaded a health-related app.

Despite all of the options and variety, however, these tools don’t seem to move the needle much on member relationships. What the industry is quickly learning is that the best way to collaborate with members is to reach out to them on their own terms.

What members really want is convenience and easy information access. They want to use the same tools they use in their daily lives to interact with their health plans and providers. They want a consumer experience in the healthcare setting. Three ways health plans can make that possible:

1.   Encourage real-time, two-way texting between members and their providers. A recent survey of 2,100 people found that more than two-thirds want the ability to text back-and-forth with their providers. It’s no surprise that the younger the member, the higher the percentage who want this option. What is surprising, though, is that three out of five baby boomers were interested in texting with their doctors too. The preference for text spans all generations.

When supporting a text platform, keep in mind that the solution should enable real text messaging-no short codes and limits-and allow members to initiate texts to their providers. Network providers should also use platforms that allow them to use their existing landline phone numbers, so members can easily identify the practice that’s texting them. Finally, solutions should keep full message histories so that all those in the provider network can hold fully informed member conversations.  

2.   Give members options. When asked about satisfaction with their providers, respondents to the Patient-Provider Relationship Study were least satisfied with practice logistics like appointment scheduling and communication. Not only do most members want text messaging, they also want things like educational newsletters and online scheduling. Equally important, however, is the ability to receive these things via technology of choice.

Health plans should ask members if they would like to receive regular, helpful tips for managing their health conditions, as well as whether they would prefer to get them by text or email. Indeed, for all automated communications like appointment reminders, recalls or newsletters, health plans should offer members the choice to receive them by text or email.

           3.   Support the use of online scheduling within the provider network. Roughly 77% of those in one survey also voiced the desire to book, change or cancel a healthcare appointment online. Other studies show that some members will choose an alternate provider just to be seen sooner. These are important facts for health plans looking to reduce network leagage. Ideally, network providers should offer real-time scheduling that shows members available appointment days, time and providers.

Meet members where they are

Too often in healthcare, a simple communication disconnect can hinder member relationships. Case-in-point: Nearly 70% of the Patient-Provider Relationship Study respondents liked the idea behind healthcare portals, yet a majority of practices still don’t offer them. Why? Because despite the interest, members often don’t sign up when portals are available.

This disconnect may be explained not by the technology itself, but by the cumbersome process typically involved in using the technology. It doesn’t reflect how most people communicate in the real world.

If the goal is to engage members to improve outcomes and get the most from value-based reimbursement models, then health plans need to look for ways to meet members where they are. Providers and health plans alike must find better ways to connect and collaborate with members. Using more consumer-friendly technology to build deeper member relationships may be one of the answers to drive fundamental change.


Jim Higgins is the CEO and founder of Solutionreach in Lehi, Utah.

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