Member engagement is essential to a positive patient payment experience and to health plans' ability to retain members throughout their health and life journeys.
During Becker's Hospital Review's 2023 Payer Issues Roundtable, in a workshop sponsored by DXC, Paul Thompson, vice president, health plan, payer strategy and industry offerings at DXC Technology, moderated a discussion about member engagement strategies. Panelists were:
- John Rosano, vice president, digital product strategy, Elevance Health
- Sham Swaminathan, vice president, enterprise architecture and innovation, Delta Dental of California
- David Weeks, senior vice president and chief digital and technology officer, NASCO
Three key insights were:
- Innovative engagement techniques are key to improving member satisfaction. The evolution of engagement techniques is taking place across a few business model features and frameworks:
- From group-oriented to tailored interaction with members.
- From acute episodic to longitudinal continuous engagement.
- From reactive ("Is my physician in the network?") to proactive ("Here are providers who can help you") user experience design.
- From assuming/presumptive to discerning/understanding approach.
- From monolithic plan-owned to modular plug-in tools.
- From explaining the past to assisting with accomplishing future tasks.
"The future can include not just provider selection and where to get care, but how to finance it, how to be predictive in the benefits that are available to people and how to manage the liability all the way into retirement," Mr. Thompson said.
- Innovating around cost transparency regulations can build trust with members. To help members obtain cost estimates for procedures, payers are leveraging AI tools to generate most likely scenarios and generate good-faith cost estimates. "If you're a payer organization, having the ability to provide that custom cost of care is so critical," Mr. Weeks said.
Partnering with brokers during the open enrollment period to make members aware of how their plan may change cost-wise in the upcoming year is another way to build rapport.
"The special sauce in creating member engagement is that as you're creating the benefit design, you're thinking about the customer's experience digitally and creating a holistic experience," Mr. Rosano noted. He added that digital containment — the ability to have cost-related or other questions answered fully digitally without having to call — is a leading metric of customer satisfaction.
- As members age into Medicare Advantage, plans face a challenge to retain them. Once members reach 65 years of age, their health needs start changing and often become more complex. Health plans wishing to retain those members need to adjust their benefit structure to reflect anticipated needs.
"You don't get the type of flexibility with benefit administration [as you do with pure commercial plans], so to successfully operate a Medicare business, you have to innovate around the edges," Mr. Shaminathan said. He recognized that his organization is facing challenges in that population segment and has collaborated with the AARP to innovate its way out of it.
As the industry evolves in its engagement strategies, technologies and approaches that are expected to play a big role include trackers, co-designing products with patient communities, harmonizing customer-facing workflows and partnering with provider organizations around data sharing.