Payer Engagement Platforms Help Empower Healthcare Consumers to Take Greater Control of their Health
By Mike Gordon
Today’s march toward consumerism is hard to miss. Empowered by the internet, mobile devices, social media, and more, people expect convenient access to a vast array of personalized information to help them make thoughtful, educated decisions on everything from buying groceries to selecting a bank to booking a vacation—and healthcare is no exception. With healthcare becoming top of mind due to national policy debates and beneficiaries bearing more of their own costs, many consumers want to confidently navigate the healthcare system and to know that they are making better decisions about their health and their cost of care.
Healthcare consumerism defined
According to the Patient-Centered Outcomes Research Institute (PCORI), which was authorized by Congress in 2010 to fund research in the field, healthcare consumerism “is generally understood to mean people proactively using trustworthy, relevant information and appropriate technology to make better-informed decisions about their healthcare options in the broadest sense, both within and outside the clinical setting.” Healthcare consumerism involves examining such items as provider reputations, treatment costs, insurance costs, medical records, consumer data, and alternatives to lower the cost of care.
Often the healthcare consumer’s journey starts with the insurance plan itself and its online presence. Today, using online technology and digital communication, members expect to be empowered with the same level of service and choices in their interaction with payers as they are in other industries—retail, in particular. Payers are responding by expanding beyond the out-of-date provider listings and bare-bones coverage summaries of yesterday’s payer portals, instead unveiling full-fledged engagement platforms that are healthcare communications and information command centers.
Enhanced online presence builds consumer healthcare engagement
While healthcare consumerism and greater access to information does not guarantee better outcomes, it does boost people’s engagement in personal health management. This leads to healthier lifestyle choices, better compliance, and a greater focus on general health that can drive earlier recognition of problems and treatments. That can mean more effective care and lower healthcare costs, benefitting members, providers, and payers alike.
In part, health plan members want opportunities for the evaluation and selection of caregivers; a clear understanding of out-of-pocket costs; a choice of care settings, including telehealth and urgent care facilities; and broad options for prescription drug purchases. They may want educational background information on medical conditions, drugs, and other treatments. This is particularly true with the growth of payer- or provider-sponsored disease management, wellness, and related ambulatory programs, where member/patient adherence plays a significant role in success.
Members also expect conveniences such as reminders to make and keep medical appointments and directions to physician locations. Drawing on their online experiences elsewhere, they expect immediate answers, instant support, transparency, high value from their insurance dollars, and satisfaction. They expect conversations with convenient and flexible communication options, ones that assist in relationship-building, but not necessarily through live agents. For members, payer platforms that supply all these things provide a focal point for modern payer communications and vital healthcare information and tools.
The most sophisticated sites help members stay engaged and compliant and take advantage of their plan efficiently and cost-effectively with a full range of communications tools, often aided by sophisticated automation to provide ultra-fast, precise, and personalized feedback. Gone are the days of long waits and repetitive telephone hold messages. Today’s engagement platforms support virtually every modern consumer touch point—text, email, chat, instant messengers, social media, phone, and digital assistants. As a result, members can communicate with payers and get plan messages anywhere, whether they’re at home, in a car, at the grocery store, or on vacation.
Omnichannel communication rules
This new communication is dubbed “omnichannel,” meaning the ability to experience unified interaction across all media, without any repetition or interruption between access points. For example, members who inquire on a website about a covered after-hours urgent care center and then move into a car can seamlessly continue the interaction using a smartphone virtual assistant to obtain further information and even driving directions to the provider location.
Working behind the scenes to help enable all this are natural language processing and artificial intelligence (AI), which analyze the interactions of thousands of members to create intelligent automated responses that can anticipate a member’s next steps and keep the journey moving forward.
Exchanges with chat or text bots (applications that run automated tasks) play an increasing role in this communication on both the consumer and payer sides. Bots may even respond in a friendly human voice and address members by name. They are becoming a particularly effective tool for active engagement when responses are based on decision-tree logic or AI.
Today, automated responses provide the immediate, intelligent answers to questions and requests for information that members crave. When a greater depth of information is needed, they can provide links to online resources or escalate sessions to live agents. Equally significant, payers often initiate member contact to offer reminders, help manage a chronic condition, or request additional information.
Enhancing quality of care
Below is a summary of the role payer omnichannel engagement platforms can play in enhancing quality of care—showing that payer, patient, and provider are all in this together:
- Reminders and alerts. Regular medical checkups and follow-up visits are important to healthcare maintenance but are not often a top priority in members’ busy lives. An engagement platform can offer the choice of opting in for reminders to schedule and to keep appointments, as well as for preventive care services such as flu shots and eye exams.
- Adherence to preventive and chronic disease programs. While delivering important health benefits, these programs have many moving parts. Participant compliance is often supported with ongoing medical maintenance care reminders, background information, payer-sponsored online educational seminars, and chat sessions with live or automated health coaches.
- Gaps in care. Some engagement platforms also identify and address gaps in care through automated reminders for scheduling appropriate exams, lab tests, and preventive services.
- Wellness and healthy aging programs. Many health plans offer wellness services and programs that address changing needs as people age. Member participation is encouraged through many of the features detailed above.
- In addition to minimizing cost, telehealth programs provide a tremendous convenience for busy members and effectively screen for members who require an in-person physician or hospital visit. Telehealth services can range from payer-sponsored nursing consultations to sessions with an independent telehealth practice. Easy access to these options on a host of devices as well as assistance in setting up multimedia communications strengthens member participation.
- Cost minimization. Payers also can actively help members minimize healthcare costs, benefitting everyone involved. For example, geolocation capabilities can remind a member currently shopping in a pharmacy of plan-discounted retail drug options or more economical mail-order drug services. They can remind a member visiting the emergency room that an urgent care facility can provide the same treatment at a fraction of the cost, or inform a member seeing a primary care physician that visiting an in-network retail clinic will be significantly less expensive. Likewise, following treatment at a more costly setting, members can be notified of less costly treatment venues for consideration in the future.
Conclusion
The internet and advances in digital communications overall have provided consumers with on-demand information access in virtually every aspect of their lives. They expect information delivered through the medium of their choice and to transition seamlessly across various media if desired through omnichannel communications. Not surprisingly, members now expect this from their health plans, too—and increasingly, they are receiving it. In fact, many payers feel they must answer these expectations to remain successful.
From deductible and copay information to telehealth and urgent care options, today’s advanced member engagement platforms deliver fast and convenient access to information, often harnessing the power of AI, voice recognition, and automation. Platforms also can proactively enable payers to reach out to members with data-driven calls to action that encourage compliance with healthcare protocols, close gaps in care, and keep members on the road to good health, as well as encourage cost-effective healthcare choices.
Mike Gordon is chief strategy officer for Healthx.