Top strategy plans, providers can use to motivate member behavior changes


As the healthcare system shifts from a focus on employee-based plans to consumer-based plans, insurers have to find new ways to engage and motivate members.

As the healthcare system shifts from a focus on employee-based plans to consumer-based plans, insurers have to find new ways to engage and motivate members.

One of the most effective strategies plans and providers should consider is personalization.

That’s according to Neal Sofian, MPH, MSPH, director of member engagement at Premera Blue Cross, and Jordan Mauer, executive vice president of marketing and member engagement at NovuHealth, a member engagement services provider. They discussed personalization strategies at the 7th Annual HEDIS & Quality Improvement Summit in Miami on October 17.

Sofian“For the first time, as we move away from purely employer-based insurance [and] consumers have more of a say in the payment and the insurance they get, [health plans] are on the hook for some of this stuff,” Sofian says, adding that

50% of all healthcare costs and 70% of chronic care costs are tied to lifestyle choices and behaviors.

New approach needed

Traditionally, plans have segmented populations and reached out through methods such as direct mailings, offering members facts about their condition and what they need to do to make positive changes. But, Sofian says, these strategies fail. 

“We’ve taken an approach that if we give people the facts they will make changes,” Sofian says. “But that doesn’t work. There’s a lot of research about what actually motivates health change and it’s things around what enables us to make change.”

People make changes based on their values, what’s most important to them, and what their habits are, he says. To effect change, plans need to understand what their members value and reach out to them in that context, he says.

“We have to learn to tailor programs to what fits in lifestyles and how people want to use it,” Sofian says.

Other industries have used personalization based on lifestyle choices and preferences to increase consumer engagement, and the technology is there to make it easier than ever. But legal and privacy challenges have hampered these efforts in healthcare, and the system is not set up to reward members for making positive changes.

“We have not built a business model around people actually taking care of themselves,” Sofian says. “The system is set up to make money when people get sick, not by keeping them healthy. There’s been a division between the people who pay and the people who benefit. The whole system is designed really to not encourage people doing the right thing and everybody-lawyers, pharma, doctors, and consumers-is to blame.”

Next: The power of personalization 



Personalization drives patient adherence

Now, regulatory measures are forcing greater change, and new programs can be built around HEDIS measures. Whether the goal is to increase medication adherence or motivate members to make diet and lifestyle changes, plans need to learn more about what drives members to really see a change.

“We collect a lot of data on people, but we’re not collecting a lot of data about people and what drives them,” Sofian says. “There’s a whole new layer of data we need to collect, integrate, and turn into a meaningful profile based upon that total picture. The more I understand you the more likely I am to motivate you.”

MauerThis is where marketing strategies and new technologies come into play, says Mauer.

“Personalization needs to happen in the healthcare context. Other industries have figured out meaningful ways to personalize care, but I think healthcare is tough. People have a lot of compliance and core responsibilities and competencies in the healthcare space.”

Working with vendors who know how to identify key population segments, identify appropriate communication channels, and offer effective incentive models can have huge benefit, Mauer says.

Effective incentive programs

Plans can use HEDIS measures to identify activities members need to do for health maintenance, develop effective ways to reach those populations based on their lifestyle and preferences, and assign points for the completion of those activities based on how difficult they are to complete. Points can then be redeemed for rewards that meet the needs and desires of those specific members, says Mauer.

“We use consumer marketing principles to get a targeted population to do an activity that’s meaningful to them by using incentives as a motivating factor,” he says. “There’s a big difference in terms of getting a cancer screening or a flu shot in terms of barriers to care. We use different incentives depending on how difficult it is to meet the goal.”

Programs that identify needs but don’t drive performance do little in terms of helping health plans meet HEDIS goals, Mauer says. Plans need services that can help reach the consumer in the way they want or need to be reached, paired with a longitudinal marketing program to execute a strategy to engage that member. It’s similar to what plans do with care management, but from a marketing perspective, Mauer says.

“You have to realize that you have to work in different ways with different populations,” Mauer says. “We isolate all those populations and treat them uniquely and differently to drive the right level of investment in outreach, and the right reward for the behavioral ask.”




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