Engaging individuals in their healthcare journey is essential for reducing costs while improving outcomes. An engaged member or patient actively collaborates with healthcare professionals, including providers, care managers, and caregivers, to improve their health. These individuals are more likely to attend appointments, adhere to prescribed treatments, and communicate their health status regularly. By taking an active role in their healthcare, they make better choices, stick to their therapies, and play a vital role in managing chronic conditions. Member engagement is a critical factor in healthcare organizations’ abilities to improve outcomes and reduce costs – and providers and payers must adopt strategic, technology-driven approaches to foster collaboration and engagement.
Why Engaged Members and Patients Cost Less
Engaged individuals proactively manage their health by scheduling preventative care, adhering to treatment plans, and seeking medical assistance before minor health problems escalate.
In contrast, disengaged individuals are more likely to delay care, skip screenings, and neglect chronic conditions like diabetes or hypertension. This can lead to costly emergency room visits, hospitalizations, and advanced treatments that could have been avoided with earlier intervention. According to research, low patient engagement leads to higher hospital admissions and readmissions. Disengaged members might also lack awareness of their health plan benefits, leading to underutilization of preventive services or missteps in managing their care. For example, it has been shown that cardiology patients with higher engagement scores had fewer adverse outcomes and readmissions while low engagement generally costs 8% more in the first year and 21% more in the following first half of the year than more engaged patients.
Understanding the Barriers to Engagement
To improve engagement, the first thing healthcare organizations need to do is understand the factors that hinder it. These barriers include:
- Limited access to information: Members may not know how to navigate their health plan or access services.
- Unaddressed social determinants of health (SDOH): Factors like income, education, transportation, and housing can significantly impact a member’s ability to engage in their care.
- Mismatched communication preferences: Individuals may become frustrated when healthcare communications don’t align with their preferred methods, such as text messages instead of phone calls or emails.
By proactively addressing these barriers, healthcare organizations can create targeted strategies that encourage individuals to take an active role in managing their health.
Improving Member Engagement is a Team Sport
Both payers and providers play essential roles in fostering member and patient engagement. Two critical strategies for success include aligning incentives and enhancing information sharing.
Aligning Incentives
To prioritize member/patient engagement, payers and providers must align incentives. Value-based care models reward providers for keeping patients healthy rather than focusing solely on service volume. Offering incentives to members, such as gym membership discounts or gift cards, can also encourage greater participation in health programs and lead to better outcomes.
Enhancing Information Sharing
Comprehensive views of each member/patient are comprised of data from sources such as EMRs and claims. If there are gaps in this information, negative interactions and decisions are likely to occur. Interoperability and the willingness to share information safely are crucial for engagement.
Leveraging Communication, Orchestration, and Automation for Member Engagement
The typical physician practice has a panel of thousands of patients and health plans cover between 25,000 to millions of members. This scale alone makes regular check-ins and engagement with even the sickest individuals challenging.
One solution is to create automated workflows that design digital care journeys with different paths based on where the patient/member is at any given time. This requires data, analytics, and knowledge of the individual’s communication preferences along with rules-based and machine-learning algorithms.
For example, when a member/patient is admitted to the hospital, an automated system can trigger SMS outreach. This text-based message can include a link directing the patient to an app or portal with assessment questions to answer. Based on their responses, they may receive personalized reminders and educational materials or even assistance in arranging transport to/from appointments.
The Power of Engagement
The connection between engagement, health outcomes, and costs is clear. However, by leveraging collaborative strategies and modern technology, payers and providers can break down engagement barriers, address social determinants of health, and deliver personalized care that resonates with individuals. Whether it’s sending a timely text message, creating automated workflows with predictive analytics, or connecting members to community resources, every interaction contributes toward the end goal of ensuring individuals receive the right care at the right time for optimal outcomes.
Matt Adamson
Matt Adamson is Vice President, Product Planning of ZeOmega.
