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By Jeff Maxwell
Most health plans have an extensive analytics organization in place. The global healthcare analytics market was valued at $23.51 billion in 2020 and is expected to reach $96.9 billion within the next decade. Health plan analysts use sophisticated technologies and modeling to mine different aspects of what is a very complex, data-intensive operation. Even so, research tells us that each year, billions of dollars are wasted and billions of dollars of revenue-generating opportunities are missed — all because health plan members across all lines of business choose to march to the beat of their own drum.
Program after program is put in place to help members “do the right thing” only to see them ignore, avoid, and shun the guidance. In the end, the analytics that lead to doing the next best thing to move members and operations forward fall short. In large part, these shortfalls come because analytics aren’t focused on clear and continuous actions based on the insights generated.
The health plans that figure out how to optimize the member engagement experience and continue to advance their efforts will be the ones who drive the cost of patient care, improve outcomes, and garner the lion’s share of the market. Those that don’t figure this out will continue to struggle with member acquisition and retention, seldom see members following the most clinically and financially prudent care pathways, and deliver suboptimal results year after year.
The good news is that any health plan can build a pathway to sustained member engagement optimization — if they really want to. It will not be easy, nor will it happen overnight, but it will be worth it. It’ll take more than just an analytics organization, and it will span use cases across lines of business (commercial, Medicare, Medicare Advantage, and Medicaid) and core areas of focus (care management, utilization, risk avoidance, etc.).
There are four key strategies that, if done correctly, can drive better member engagement, behavior, and outcomes:
1. Understand where the health plan stands.
This might sound simple, but it isn’t. Understanding where the health plan stands requires taking a hard look at the current performance landscape. It involves efforts like examining current utilization trends and building the foundation for discovering real, high-level member intervention opportunities. It looks at current delivery mechanisms, such as digital engagement vendors, to assess current performance. Understanding where the health plan stands is the foundation for a member engagement optimization business case.
Many health plans skip or underinvest in this assessment step, choosing to make assumptions about the performance and members. This ultimately leads to an inherently flawed go-forward strategy. It might work. Even a coin toss is probable to land on heads 50% of the time. However, most health plans don’t have the runway or market share to play with those odds. Taking the time to assess where opportunities reside is the only way to create a data-driven, justified go-forward business case. Health plans that want to significantly optimize member engagement will take the time and invest in this important effort. The result will allow the health plan to set the right goals and establish the foundation for success in member engagement optimization efforts.
2. Narrow member targets.
With a business case (or cases) set, it’s time to dig into the nuances and behaviors of members. This effort goes beyond mere data analytics. Deciding which portions of a member population to target involves an extremely complex and detailed analysis of member data, including other key causal factors like social determinants of health data, to clarify the best chance of success even before investing in outreach efforts. This effort should leverage both technology (AI) and domain expertise and look at member behavior across lines of business, disciplines, care settings, networks, and a host of other factors. Discovered insights on engagement and impact help create focused segments and member clusters that go beyond normal segmentation efforts.
Health plans that do this right will come away with data-driven insights that frame the business use cases most likely to succeed. It will let them architect goals for highly targeted populations, set up meaningful tracking mechanisms for those goals, and set the stage for crafting a new and highly effective level of engagement outreach.
3. Launch an engagement ‘offensive.’
Rather than taking the time to understand their members, most health plans just begin with outreach and engagement campaigns. However, the time to assemble resources for an engagement “offensive” is after obtaining intelligence and fully understanding the objectives. This is the path to sustained success in program adoption and member pattern adjustments.
The engagement offensive has three core steps:
- Process validation: Ensure processes are in place for critical efforts such as customer relationship management system integration and campaign approvals through member marketing, legal, compliance, and other relevant organizations. Failure to do this is a recipe for disaster.
- Content creation: The purpose of prework is to create specific personas based on specific criteria. Now is not the time to create a “one size fits all” messaging campaign. Build a library of appropriate messaging, outreach channels, and intervention touchpoints that can be measured and adjusted as needed once performance metrics are generated.
- Outcome measurement: The point of these efforts is to create an environment for success and then measure the impact. A system should be put in place that can get feeds from multiple systems, process that data, and provide timely feedback. Omitting this step means falling short once the first campaign is completed.
Launching the right campaigns with the right messaging to the right audience at the right time is crucial for successful engagement optimization. It requires prework. It also requires fearless and relentless execution, measurement, and the ability to make changes based on what the data conveys.
4. Continue to optimize.
The first three optimization strategies push the health plan into member engagement orbit. Automation ensures that it stays there. As the store of intelligence builds, automation (and some machine learning) will engage new members with proven interventions. Flows can be set up to automatically nudge existing members using proven methods based on their profile, behaviors, and tendencies. This is not an easy strategy, but it is the one that makes this entire process truly scalable for the organization. Don’t ignore it.
Optimizing member engagement allows for an improved member experience, guides members to the best outcomes, and helps provide the most cost-efficient means of delivering care, all while impacting overall affordability. It starts with taking a hard look at where the health plan organization is today. It then requires understanding the members in the organization population on a whole new level. It demands fearless and focused execution and commands a continuous improvement mentality that will not settle.
Jeff Maxwell is the executive vice president of healthcare solutions at NextHealth Technologies. He has more than a decade of experience working with healthcare organizations, health systems, and health plans.
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