Member Engagement: A “Must-Have” for Health Plans Today

As Health Reform continues to unfold, the pace of change is picking up speed, as new models of reimbursement, care delivery and access are taking shape.

These shifts on the provider side should represent good news for millions of Americans that need better support from the healthcare system, especially since many of those with chronic disease aren’t currently getting recommended care. Coupled with the fact that most patients do not adhere to their medication and treatment regimens or recommended lifestyle and health behavior changes, and it’s easy to spot some of the challenges ahead.

Here’s where the payer side, particularly health plans, can really help.

Health plans have ready access to claims data and other relevant clinical information plus a direct line to their members for targeted messaging and clinical interventions. While not a traditional strategic imperative, health plans do have a significant opportunity to help drive behavior change, reduce risk, and produce positive health outcomes for their members.

Most plans already provide member portals and other helpful resources, and many have begun to focus on enhancing these activities and initiatives to enhance their value and impact. But, to compete effectively, in this rapidly shifting market, they will need to re-orient their mindset and approach to be far more consumer-centric.

Consumer Power

After a decade of slow growth, Healthcare Consumerism has begun to take hold. Participation in high deductible health plans (HDHPs) is at a record level with 23% of all those with employer-sponsored insurance now enrolled in an HDHP. Other emerging factors such as price comparison tools, quality ratings, and retail health alternatives will continue to put more power into the hands of consumers.

Health plans need to respond to this trend and design strategic solutions or partner with best-in-class service providers for their member populations. This puts a greater burden on member engagement outreach and interactions that are positive, relevant and trust-building.

This will not be easy. Recent surveys reveal a deep trust gap between insurance companies and their members. The KMB Group survey of 34,000 consumers, find that only 22% of members identify their health plans as a “trusted source.” This compares to 80% for physicians.

And this year’s American Customer Satisfaction Index (ASCI) report indicates that customer satisfaction with health plans declined between 2013 and 2014, stating, “There is no area where health insurance companies offer an outstanding experience.”

Member Engagement

Member engagement is new territory for most health plans, and with Medicaid expansion, the influx of age-in Medicare members and the newly insured, it is increasingly important to provide consumer-oriented communications interactions, and interventions.

As Star Ratings and other quality metrics rise in prominence, and consumer brand preference and loyalty begin to become important factors, health plans will find themselves striving for excellence in consumer experience, though outstanding member engagement.

We see a number of areas that need to be addressed in developing an effective member engagement strategy:

1. Understand how consumers think and operate in their own health and healthcare world.

Health plans need to conduct a thorough and honest review of the outreach that goes to members, along with any and all on-going interactions, the customer service function, and related areas. This is the essential starting point for meaningful change and can help uncover insights about the consumer decision process. Additionally, areas such as behavioral economics provides many important learnings and can be a good guide for creating a messaging strategy to members.

2. Adopt a member-centric marketing system designed around their concerns and interests.

Using a consumer marketing mindset in establishing the communications strategy and identifying measurable actions, health plans need to become be a valued partner. Strategic messaging needs to be incorporated into all member touch points and aspects of outreach. Too many health plans still rely on dated letters from their Chief Medical Officer as the introduction to any number of health enhancement initiatives. Scrap them and find ways to make the content meaningful, relevant, and credible to the recipient.

3. Strategically align and integrate all health improvement service offerings.

Most health plans can check all the boxes relative to their service offerings in wellness, care management, disease management, pharmacy coordination, and an array of other services – but bringing them all together in a seamless solution is what members truly want and need. And by providing an overlay of measurement and feedback, plans can help ensure members receive what is most meaningful to them.

These are ways health plans can think about advancing their capabilities toward being member-focused and engagement-oriented. There’s a lot they can do to actually change member behavior, lower risk and contribute to better overall health outcomes – which should produce stronger margins and returns.

Health plans can learn and adopt many consumer marketing strategies from other industries, all of which can more create positive experiences in healthcare. In a consumer health plan market, the winners that emerge will likely be those that excel in member engagement.

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What Is The Focus of Worksite Wellness Today? – A Series – What Is Health? (Does It Matter?)

The field and practice of worksite wellness today basically revolves around three terms – health, wellness and wellbeing. Other terms also seen used include: thriving, flourishing, health promotion, optimal living and quality of life. But the big three are health, wellness and wellbeing.

Since these terms are used interchangeably or as synonyms, I have wondered just how different or the same these terms are? When I framed out this question in my mind, I thought it would be simple enough to just look-up their definitions and I would have my answer.

But, boy was I wrong. Definitions only got me so far and not very far at that. It appears that a clearer picture requires understanding the term’s concept and context, as well as its definition.

What Is Health?

Probably, the most commonly cited definition of health is the 1948 definition by the World Health Organization (WHO). “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

The 1994 Mosby, 4th Edition, Medical, Nursing and Allied Health Dictionary defines health as: “A condition of physical, mental and social wellbeing and the absence of disease or other abnormal condition. It is not a static condition.”

Rice University defines health as being “a multi-dimensional concept that is usually and measured in terms of: l) absence of physical pain, physical disability, or a condition that is likely to cause death, 2) emotional well-being, and 3) satisfactory social functioning.”

Wikipedia sees health as being “the level of functional or metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental or social challenges.”

Fritjof Capra and Pier Luisi in their 2014 book, The Systems View of Life, define health as “a state of well-being, resulting from a dynamic balance that involves the physical and psychological aspects of the organism, as well as its interactions with its natural and social environment.”

The 2013 Edition 22 of Taber’s Cyclopedic Medical Dictionary defines health as “a condition in which all functions of the body and mind are normally active.”

In Merriam – Webster’s 2006 Medical Dictionary, health is “(1) the condition of an organism or one of its parts in which it performs its vital functions normally or properly; the state of being sound in body or mind; freedom from physical disease and pain. (2) the condition of an organism with respect to the performance of its vital functions, especially as evaluated subjectively (How’s your health today?).”

Stedman’s 7th Edition Medical Dictionary for the Health Professions and Nursing, 2012, has defined health as “(1) the state of an organism when it functions optimally without evidence of disease or abnormality; (2) a state characterized by anatomic, physiologic and psychological integrity; ability to perform personally valued family, work and community roles; ability to deal with physical, biologic psychological and social stress; a feeling of wellbeing; freedom from the risk of disease and untimely death.

Unlike health status which is a fixed state at any one specific point in time, health is a much larger concept. “Health is largely a subjective experience whose quality can be known intuitively but can never be exhaustively defined or quantified.” (Capra and Luisi, 2014) Health is therefore relative, subjective and multi-dimensional. How we define life will determine how we define health. Since life depends on the natural and social environments, so does our health.

When examining and considering definitions, it is important from a conceptual perspective to remember that definitions are only part of the perspective. For conceptual clarity, one also needs to consider context and relevancy as being equally important as areas to focus on as well.

Understanding health in relationship to worksite wellness is not as simple as defining the term.

Program Focus

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