Last week, we met Sally. In our discussion about Sally, we determined that the motivations behind most Medicare Advantage member engagement strategies—namely, reduced cost via lower utilization—have little appeal to the average member. Unless the member is recently discharged from the hospital due to a recent health scare, they may not be as motivated by a program that is designed to keep them out of the hospital. In fact, they might greet such programs with skepticism because, to the member, the benefit seems more skewed toward money saved by the plan, rather than an interest in the member’s health. These conflicting views could lead the member to think that the health plan can’t be trusted, and no Medicare Advantage plan wants to end up in the “untrustworthy” column.
There is, however, a way to balance the needs of the member and the plan.
Let’s start with simple, convenient access to information. Health plans have an advantage over hospitals and doctor’s offices based on the breadth of data provided by a claims feed. Plans know all of a member’s interaction with the care system and they can see trends and variances in a member’s utilization profile. Furthermore, plans can correlate utilization to outcomes, to determine what usage patterns lead to more serious issues in the future and which usage patterns lead to turnarounds or improvements for members. When that information is married with clinical data, whether through lab reports or health assessments, it becomes enormously powerful.
The challenge is that most Medicare Advantage plans, if they gather this data, hoard it. They feed it into actuarial tables or send it to clinical analytics, leading to better refinement of the financial models for risk exposure and better clinical risk stratification, leading to higher reimbursement. And remember, only using the information in this way comports with our member’s concern that their health plan is untrustworthy and only cares about the money, not about their health.
But what if your plan shared that information with members?
What if you provided a simple-to-understand outline of information to members? It could be a picture of their health: labs, utilization profile, frequency of primary care visits, and any other information readily available, including education information on their chronic conditions. This snapshot would not include specific clinical recommendations, but it would serve as an onramp to better information. The profile could include ways to get more information, including phone numbers for nurses and websites for education, all of which would round out the educational component.
Providing education that fits the member’s context is critical. It prevents them from trawling the internet for diagnoses for symptoms that they don’t understand and begins to provide a baseline for how they feel every day. It builds trust between the health plan and the member, preparing them for services and options that will improve their engagement and health further down the road. And, it leverages the data that the member is generating, not merely for the sake of improved economics for the health plan, but in pursuit of better health and better engagement for the member.
As a member’s trust grows, their likelihood of participation in programs of higher impact grows as well.
In our final post, we will talk about how the types of engagement programs make a difference and differentiate health plans in their service of members.