Setting Goals for Member and Patient Engagement

Meet Sally. Sally was diagnosed with congestive heart failure several years ago. Now 80 years old, she lives alone, making ends meet with income from Social Security and the pension she earned after teaching in public schools for over thirty years. She is generally self-sufficient, although she occasionally forgets to take her medicine or monitor her weight. Most days, she says she feels “pretty good.”

Sally’s daughter lives about 40 miles away. Her daughter wishes she lived closer so she could stop by every day, but she is only able to swing by on the weekends and rarely during the week.

The above scenario is so common that it’s tempting for health plans to jump straight to the question, “How can we engage our members?” But first, we must be clear about the goals of a member/patient engagement strategy.

Relationship between insurer and insured as a commodity

Last week, we wrote extensively about the way relationships between members and health plans are reduced to a commodity. Members consider the speed and convenience of scheduling appointments with doctors and the cost of co-pays. Their annual choice of one plan over another is based on their satisfaction with their experience over the previous year. Unfortunately, this is a race to the bottom:

  • Plan A may have a $20 co-pay on doctor visits and a $5 co-pay on generic drugs
  • Plan B can then advertise $15 and $2 on the same services

The member is challenged to choose between the disruption of moving from one plan to another, or sticking with their current plan which offers a lower economic benefit.

This scenario reinforces the perception that health coverage is a commodity and that the sole role of the health plan is to streamline the financial transaction.

  • It treats the member’s health as a secondary consideration.
  • It assumes access to care is a foregone conclusion.
  • It negates the value of a differentiated relationship around health.
  • Members are acutely aware when they become a unit of revenue and part of a transaction. That may not result in a change in health plan at open enrollment, but it does give them pause as they think through their health concerns.

The goal: an experience of healthcare, not a commodity

The purpose of member engagement cannot be merely a simplification of the financial transaction. The goal should be to create an environment that enables and supports members to navigate the health system more simply, so they can improve their ability to care for themselves, and experience an improved sense of health and wellness.

Remember Sally from our intro? Consider how cost and transaction simplicity is far from her chief concern.

For Sally, a difference in co-pay on her generic drugs isn’t meaningful; she is fortunate that her income is more than adequate for her expenses. What she needs is:

  • Simple, inexpensive support to remind her to take her medicines every day
  • Support to determine if her recent weight gain is due to swelling and fluid retention associated with her heart failure or her rediscovered love for baking pies
  • A way to keep in touch with her daughter, to provide peace of mind that she’s feeling OK and taking her medicines, without having to talk every day and without having to be nagged about it when her daughter calls

The goal of a member engagement strategy should be to differentiate the services and support for keeping patients healthy and aware of their health status. This is the intersection of appropriate care and economic gain:

  • Appropriate care because the establishment and maintenance of good daily health routines will keep patients home and out of the hospital
  • Economic gain because a patient at home is intersecting with a care team earlier, early enough to change her medicines and improve her exercise routine, avoiding an unnecessary hospital stay

One other factor: the caregiver connection

Perhaps the most powerful motivator for choosing a plan comes down to a relationship far more important than the one between member and insurer. When Sally makes her open enrollment choice at the end of the year, the option that keeps her daughter involved and provides peace of mind about how Mom is doing offers a clear, positive differentiator. No mechanism does more to keep members engaged than bringing their caregivers into the loop.

Coming up next

There are concrete options to fulfill member engagement goals. We will start outlining how to move toward those goals in our next article.

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  1. Pingback: Getting Practical on Member Engagement | Pharos Innovations

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