Optimizing member engagement for effective population health management

I. Introduction

Payer-led care management serves as an important mechanism through which payers can exert influence on health outcomes, close care gaps, and enhance the performance metrics of health plans. It is progressively becoming more important in the rapidly evolving healthcare landscape, which is characterized by increasing physical and behavioral health challenges, escalating healthcare costs, and shrinking premium margins. 

Member engagement lies at the heart of successful payer-led care management. Effective member engagement involves the continuous, active involvement of individuals in managing their health and wellness, which is crucial for driving behavioral change and improving clinical outcomes. Furthermore, high levels of member engagement are strongly correlated with increased member satisfaction, enhanced retention rates, higher quality scores, and improved overall health plan performance.

Despite its potential benefits, the industry has historically struggled with effectively engaging members. Current industry statistics reveal that 80% of identified at-risk members remain unreached, the average engagement rate across high-risk groups is below 30%, and 60% of members contacted by care management fail to adhere to recommended care plans. These figures underscore the urgent need for a more robust and strategically nuanced approach to member engagement.

II. Stages of Member Engagement and Related Metrics

Optimizing member engagement requires a comprehensive understanding of the key stages involved, along with the metrics that define success at each juncture. The end-to-end member engagement process can be categorized into the following four stages, though many payers consider only the first two as member engagement:

1. Target and Outreach:
   • Objective: Identifying and reaching out to the appropriate members who require care management services.
   • Key Metrics: Number of outreach attempts per member, high-risk member outreach percentage, targeting accuracy, etc.
     
2. Successful Member Contact:
   • Objective: Establishing initial contact with the member.
   • Key Metrics: Number of successful calls or texts, contact success rate, the utilization of member-preferred communication channels, etc.
     
3. Engagement During Interaction:
   • Objective: Actively engaging the member in a meaningful conversation to ensure they understand and are motivated to follow through on recommended interventions.
   • Key Metrics: Call duration, follow-up rate, member satisfaction score, etc.
     
4. Behavior Change:
   • Objective: Achieving measurable changes in members’ health-related behaviors following engagement and intervention efforts.
   • Key Metrics: Adherence rates, improvement in health outcomes such as reductions in hospital readmissions, etc.

III. Challenges and Solutions in Member Engagement

Challenges encountered during the member engagement process can vary depending on factors such as members’ age, disease state, socioeconomic status, and geographic location. However, certain common challenges persist across these difference contexts, along with potential solutions applicable to each stage of engagement.

1. Target and Outreach Stage

• Key Challenges:
  • Incomplete, Inaccurate, or Untimely Data: Inaccurate data can result in missed opportunities to identify and engage members who require care management, leading to reaching out to members who no longer require intervention or missing those who do. 
  • Lack of Robust Predictive Analysis: Makes it challenging to predict which members are at risk and need engagement and could result in inefficient targeting and outreach efforts.
  • Insufficient Capacity or Infrastructure: Limited resources can hinder the ability to conduct sufficient outreach attempts.
    
    
• Solutions:
  • Accurate and Timely Stratification Data: Leveraging a combination of clinical and non-clinical data, including claims, admission-discharge-transfer (ADT) alerts, and social determinants of health (SDOH) data, ensuring continuous updates for real-time relevance.
  • Predictive Analytics for Proactive Outreach: Investing in predictive models that allow for the proactive assessment of member needs, enabling timely and effective outreach. Also, regularly refining models by comparing predicted outcomes with actual results to improve accuracy.
  • Outreach Infrastructure & Capacity: Expanding care management capacity and infrastructure, such as email, text messaging, and digital tools, to ensure sufficient and timely outreach.

2. Member Contact Stage

• Key Challenges:
  • Outdated Contact Information: Incorrect or outdated phone numbers and email addresses can result in many members being unreachable.
  • Preferred Communication Methods Not Used: Members may have specific preferences for how they wish to be contacted, such as via phone, email, or text. Not adhering to these preferences can lead to low engagement.
  • Inconvenient Timing: Reaching out to members at inconvenient times, such as during work hours, can reduce the likelihood of successful contact.
    
    
• Solutions:
  • Updated Contact Data: Implementing processes for regular verification and updating of member contact information to ensure accuracy.
  • Preferred Communication Methods: During the onboarding process, asking members for their preferred modes of communication. Also, utilizing digital solutions and tools to facilitate various communication channels such as phone calls, emails, text messages, and app notifications.
  • Preferred Communication Timing: Conducting surveys or ask during onboarding about preferred contact times. Implement systems that allow members to schedule calls at their convenience. 

3. Engagement During Interaction Stage

• Key Challenges:
  • Lack of Trust and Understanding of Benefits: Members may distrust their health plan or lack a full understanding of the benefits of engagement, leading to disengagement.
  • Overwhelming Communication: Excessive communication from multiple payer departments can overwhelm members, leading to disengagement.
  • Changing Care Managers: Frequent changes in care managers disrupt continuity of care and hinder trust-building efforts.
    
    
• Solutions:
  • Trust and Communication: Developing onboarding programs that provide clear, transparent information, set realistic expectations, and articulate the tangible benefits of member engagement.
  • Continuity in Care: Assigning a consistent care manager to each member whenever possible, fostering strong, trusting relationships, and ensuring continuity of care.
  • Frequency of Communication: Coordinating communication efforts at the organizational level to avoid overwhelming members, ensuring a cohesive and manageable communication strategy.
  • Personalized Engagement: Segmenting members not only by risk categories but also by consumer personas, allowing for tailored engagement strategies that align with individual preferences and behaviors.

4. Behavior Change Stage

• Key Challenges:
  • Lack of Clear, Actionable Interventions: Ambiguity in recommended interventions can confuse members and hinder their ability to act.
  • Failure to Customize Interventions per Member Needs: Generic interventions often fail to resonate with members, reducing their effectiveness.
  • Lack of Follow-Ups: Insufficient follow-up processes can stall progress and impede sustained behavior change.
  • No Tracking Mechanisms for Behavior Change: Without effective tracking mechanisms, it is challenging to measure and refine engagement strategies.
    
    
• Solutions:
  • Customized and Specific Interventions: Providing members with clear, specific, and actionable steps tailored to their individual needs, circumstances, and preferences, enhancing the likelihood of adherence and positive outcomes.
  • Follow-up Surveys: Implementing regular follow-up surveys to address barriers to adherence and maintain engagement, setting up inbound communication channels to facilitate ongoing support.
  • Behavior Measurement: Implementing systems and metrics to track and measure behavior changes resulting from engagement efforts (e.g., the percentage of prescribed medications picked up). Also, continuously refining strategies based on measured outcomes to improve effectiveness.

IV. Conclusion

Optimizing member engagement is paramount to the success of payer-led care management programs. By systematically addressing the challenges at each stage of engagement and implementing targeted, data-driven solutions, payers can significantly enhance member engagement, drive sustained behavior change, and improve health outcomes. Furthermore, leveraging provider collaborations, partnering with third-party organizations with grassroots reach, and engaging members earlier in their health journey — when they are still low-risk — can amplify the effectiveness of population health management efforts. In doing so, payers can ensure that their care management programs deliver not only superior health outcomes but also a strong ROI, securing their position in an increasingly competitive healthcare landscape.

Pankhuri Sharma is Strategy & Operations Leader at Humana. She is based in Chicago and can be reached at pankhuri0806@gmail.com.