Why Data is Healthcare’s Direct Line to Improving Member Service, Engagement and Experience


Organizations as diverse as social media platforms, online shopping websites and healthcare companies often consider that their business is making connections, selling goods or providing care services, respectively. While these are the outputs of these businesses, there’s a key factor relevant and important to all businesses—not just those mentioned above—that doesn’t always receive the focus that it should: data.

What these organizations and others have in common is the potential ability to solve problems for customers using the data they have. These companies offer many goods and services, but data may be their most valuable commodity. Social media outlets are adept at using data and could be thought of as data organizations first and foremost—with the ability to sell an estimated $226 billion worth of highly-targeted ads in 2022—and social media platforms second.

While the consumer goods and services industries lead the way in using data to improve the buyer experience through targeted campaigns, healthcare now understands data’s importance as a tool to benefit the industry and healthcare consumers.

“Healthcare payers must confront multiple challenges in order to simultaneously manage costs and provide a quality member experience,” according to Improving the Member Experience: Strategies for Healthcare Payers. “Improving member engagement is a fundamental way to address these challenges, as it helps to increase member ability to self-manage and make informed medical decisions.

"Additionally, when members are engaged by their payer organization, they have a more positive member experience which drives positive financial and clinical outcomes. However, effectively engaging entire member populations and improving the member experience is no simple task.”

Although providing healthcare is far more complex than selling a pair of jeans, utilizing the data lessons learned from other industries can help healthcare improve member engagement and experience.

Data overload

The healthcare industry is similarly inundated with data: it generates massive amounts of it. By 2025, it’s estimated that healthcare will generate 36% of all data worldwide annually. Healthcare, projected to create 181 zettabytes of data yearly by 2025, produces more data than manufacturing, financial services, media and entertainment.

The amount of healthcare data isn’t necessarily the challenge—although the sheer volume can be problematic and daunting—accessing and acting on it is.

Healthcare organizations lag behind other industries when using data in the decision-making process, especially those in vulnerable, underserved populations. The physical location of data causes much of the problem and difficulty in making sense of the information and acting on it.

Hospitals, healthcare facilities, primary care providers, specialists and other care providers hold separate electronic health records. Older members may have paper records that will never be digitized. And with the advent of internet of things-connected devices, remote patient monitoring and personal wearables, more data is available than ever before. But this data is frequently housed in proprietary software, making it difficult or impossible to access.

According to a Harvard Business Review article, “More recently, that data has been joined by information streams from monitoring devices, fitness trackers and smartphones, patients’ own assessments of their health, genomic data, and readily accessible population-level data on social factors that profoundly affect health: employment status, income level, environmental quality, level of community support, and so on.”

But even with this abundance of potentially actionable data, little of it has coalesced in a single, centralized database accessible by health plans and providers who could potentially use the information to improve the health plan member experience as well as health and financial outcomes, which can improve health equity.

“As data about our health piles up—thanks to sources like electronic health records, personal fitness apps and gadgets, and home genome test kits—we should understand a lot more than we used to about what’s wrong with our health and what to do about it. But having a lot of data is not enough,” points out a Harvard Business Review article. “We have to be aware of what we have, understand what it means, and act on that understanding.”

To excel in member care and to create the best experience, the healthcare industry must get this data to health plans, providers, pharmacists, family and other care providers who can help make the decisions that will positively impact each member.

Whole member care

To solve problems, such as health-related social needs or improving health equity by using data health plans must be able to access and act on the information. Many opportunities exist to improve healthcare by ensuring there is high-quality utilization, not just utilization for utilization’s sake. A holistic, value-based approach to member health remains an aspirational healthcare goal; data can help make it a reality by identifying individuals with chronic conditions and demonstrating successful health outcomes, as well as cost savings.

“Advanced analytics can potentially allow us to combine all of these data sources to start developing a clearer picture of health status and the effectiveness of care at all levels — from individuals to groups of patients with the same diagnosis to entire communities,” authors state in a Harvard Business Review article.

Oftentimes health plan members require several different care services to maintain or improve their health, including substance abuse management or mental health challenges. Members may face several concurrent challenges and could benefit from non-emergency medical transportation, remote patient monitoring and personal care services.

Collecting data from within the member’s home may be the most advantageous way to understand the challenges of everyday life. An in-home caregiver, for example, will have firsthand information and data, which can help health plans understand what prevents their members from getting healthcare.

The member may have:

  • behavioral health issues;
  • transportation challenges;
  • food insecurity; or
  • need help navigating the healthcare system.

As a health plan’s eyes and ears, in-home caregivers are in a unique position to not only collect member data, but to act on it in a way that improves the member experience.

Often the only way a health plan will realize these needs exist is through data analytics, but, as mentioned earlier, that data is far-flung and difficult to access. In the meantime, utilization costs continue to rise as members receive suboptimal services, which, if coordinated using data, can support positive health outcomes and lower costs.

The healthcare industry is at a data crossroads. Will it bring together data to improve member service, engagement, experience and outcomes? Or will the status quo prevail?

The future of health equity among vulnerable populations depends on disrupting the status quo.

Seth Ravine is Senior Vice President of Strategic Solutions at Modivcare.

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