Healthcare payers are under pressure on numerous fronts. They are being asked to manage a population with increasing chronic conditions and health challenges at younger ages. At the same time, they face unprecedented competition from new entrants focused on Medicare, to organizations offering disease management programs directly to employers.
Today’s healthcare consumer is also raising the bar as people purchasing health insurance are increasingly seeking the same level of service offered by online retailers like Amazon. They want their individual needs to be met with around-the-clock convenience and personalized interactions on their preferred communications channel. Yet, most payers are failing to meet these expectations. Why?
Disconnected data is creating poor experiences
It often boils down to siloed information. When your data is disconnected, and your organization relies on disjointed legacy IT systems, members repeat information and call multiple times to get answers. I know somebody who recently received a serious diagnosis from a primary care doctor and then waited three weeks to get a referral approved by the insurer to see the surgeon. Why? His file had been misplaced.
Patients are having to triage their own healthcare experience and connect the dots across touchpoints because their health insurer manages enrollment, clinical programs, and bill payment in disconnected teams and systems. Clunky and dissatisfying experience ultimately leads to declining loyalty and trust, which may compel members to find another plan.
Payers have a central role in fixing healthcare
However, there’s definitely a path forward. Having worked at Blue Shield of California for eight years, I’ve seen firsthand the tumultuous changes the industry has faced as a result of the Affordable Care Act (ACA), recent mergers and acquisitions, as well as the emergence of consumerism in healthcare. The good news is that these changes have inspired health insurers to move beyond managing risk to helping members manage their health.
I joined Salesforce in 2012 because I thought I could make more of an impact from the technology side, to connect the data silos and communications around a member’s healthcare journey. Back then, we had a vision to empower health insurers to engage members, doctors, caregivers, and even family members in a connected health journey in which the health and wellbeing of the member is priority #1. We continue to hold that vision.
Personalized member experience
Payers are looking for solutions that fulfill their members’ demand for seamless experiences. This requires addressing the disconnect between multiple legacy systems and point solutions so that call center agents, providers, and care teams can collaborate and share appropriate information about members and effectively engage members at every touchpoint in real time.
For example, take a look at UnitedHealthcare. They implemented Salesforce to connect their legacy systems in real time — across the enterprise — which helps render a complete view of each member’s data, supporting more efficient care, management, and collaboration. Now, UnitedHealthcare customer care representatives can automatically track engagement histories when members call with routine claims-related questions. The representatives can easily address billing issues or recommend in-network providers and services as well as the highest-quality, most affordable care option.
Proactive and contextualized communications
With a unified view of the member, payers can deliver contextualized communications tailored to members’ demographic background, health status, and personal preferences.
For example, a senior citizen with osteoarthritis would likely prefer to connect with payers over the telephone and seek care in a doctor’s office or home visit. By contrast, a better engagement tactic for a millennial with diabetes might be an SMS chatbot, mobile app, or within a payer portal. We have the technology to effectively and seamlessly engage members of any age in their health. Let’s put it to good use.
Scaling care management programs
With the incidence and prevalence of chronic illness and co-morbidities in populations, payers need the ability to deliver larger-scale interventions, taking into account not only individual member characteristics but also wider population health risks. Consider the social determinants of health (SDoH), such as a person’s housing status and their ability to access healthy food, healthcare services, and transportation. These collective barriers often have a greater negative effect on members’ health than access to care.
Today we have healthcare payers and providers using Salesforce to capture information about member social barriers and then engaging members in new ways to improve their outcomes. Some members simply need more support. While one person may require a periodic check-in-call from a care manager, another may need a daily text survey to stay engaged.
How can we deliver this level of personalized member engagement at scale? Welcome to automated journeys that can be customized for individuals or populations, serving them relevant information on their preferred channel at a time when they are ready to engage. Can this technology really engage members in their health?
According to 180 Health Partners, they used this technology along with their clinicians to engage with more than 500 opioid-dependent pregnant mothers pre-delivery to help them stabilize their dependence, reduce life and environment stressors, and ultimately reduce the cost, pain, and suffering for the babies born with neonatal abstinence syndrome (NAS). They achieved over 70% reduction in neonatal care intensive hospital stays and retained 100% of mothers in a stabilization program post-delivery.
If technology can help engage one of our most vulnerable populations, it can certainly motivate healthy behaviors across our member populations.
As Phil McKoy, CIO at UnitedHealthcare stated, “A lot of the shifts that you've seen in retail or financial services, those technology shifts are now coming to healthcare. … There is a lot more focus on consumer digital, a lot more focus on personalization, and a lot more focus on giving control back to the people that we serve.”