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What Does Simple and Affordable Healthcare Look Like?

MHE PublicationManaged Healthcare Executive August 2019 Issue
Volume 29
Issue 8

Patient experience should take a front seat at healthcare organizations, but what does that entail?

Money healthcare concept

Think of a recent consumer experience that you’ve had and odds are it is not related to your use of the healthcare system or related or your health insurance. More often than not, we cite examples from the retail, banking, hospitality or travel industry where elements of transparency, convenience, and reliability combine to generate a memorable and lovable experience. Surrounded by these examples every day, consumers have come to expect the same level of experience in all aspects of their life including healthcare.

Our members also tell us this. Ultimately, they are seeking our help in making their experience simple and affordable. This is no small task. However, we have taken it on with a focus to develop trust, engagement, and activation with those who use our health plan.

An easy-to-navigate web page and mobile experience that provides personalized information (easy access to information about current spend against deductible and OOP limits, finding a high-quality, in-network provider, and more affordable along with access to EOBs) is table stakes these days. Creating relatable, relevant ,and timely communication and tools that demonstrate the value of a health plan to the consumer is where the opportunity lies.

Two key ways to enhance experience are making cost and quality information easily accessible and supporting coordination and navigation of care through consumer personalization and empowerment.

Personalizing the experience

Who enjoys getting a colonoscopy? The idea of prepping for and having the test is a barrier to even going to have a physical at a certain age. In an effort to enhance colorectal cancer screening (CRC) rates, we identified individuals not up to date with screening recommendations who also had no primary care visits in the prior year where a recommendation for screening might occur.

Related article: 10 Ways to Improve the Patient Experience

Understanding these individuals were not engaging with the care system and knowing a big barrier to CRC screening is fear of colonoscopy, we mailed FIT kits-a home based screening test for CRC-to over 30,000 members along with information on CRC screening and the value of establishing a primary care relationship. The communication was timely and relevant to the audience as just over 24% completed the test and returned the kits. Those with positive findings were all referred for further assessment and screening leading, in some cases, to early cancer diagnoses or identification of polyps requiring more frequent monitoring. Personalizing the campaign increased CRC screening and engaged members with primary care.

Empowering consumers

Healthcare can be complicated, right? Shopping for prescriptions shouldn’t be. Recently, we launched a pharmacy price transparency tool in our web and mobile experience that provides pricing at any pharmacy. Through a real time benefit check, a consumer can see their OOP cost and plan liability for individual drugs or total cost for all of their prescriptions at a given pharmacy. If a lower cost pharmacy is nearby, they can initiate a transfer of prescriptions with the push of one button.

This has helped save countless dollars for consumers and plan sponsors. This same capability is being piloted in our providers offices to allow the prescriber to see and share with their patient what the real drug costs are based on negotiated rates and current benefit status.

Communications and plan tools must feel relevant and demonstrate value to the consumer if we wish to gain trust and deliver on our members expectations of a simple and affordable experience.

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