When most plan administrators focus on member engagement, they think about open enrollment. Of course choosing the right coverage is an important step, but it’s only one piece of the puzzle. It is equally important for the members to know how to find and use the right care included in their coverage.
Why? Because care and coverage go together and when members are engaged to improve their health and wellness, they are more likely to take positive action and change behaviors.
Member engagement can be improved by creating a positive and consistent experience across their journey. This requires a systematic approach of orchestrating touchpoints — a touchpoint being any interaction between the member and their health benefit.
Here are some touch points longitudinally mapped throughout the member journey. You can also leverage a care navigation and patient advocacy solution that integrates these touchpoints and turns them into a continuous journey to build trusted long-term relationships.
Reaching out to members during enrollment is a great way to start the communication. This opportunity should be used for explaining benefit design, options and answering coverage specific questions for each member.
Post enrollment (after the member has signed up) is an opportunity to determine satisfaction and understanding of the benefit collateral, design and customer service for future improvements. During this interaction, be sure to track responses that require timely follow up for members needing additional assistance.
Many digital programs use assessments at time of sign up. Use this touch point to engage members, segment your population for better targeting and determine the appropriate follow-up plan for each segment.
Preventive Care Outreach
Members aren’t used to seeking preventive care. Significant percentage of members enrolled in high-deductible plans are avoiding care until the last minute or using the most expensive option available. Use the right timing to reach members for preventive care.
If your plan design include VBID elements, and it reduces the out of pocket costs for members to use high quality services, you can use this as an opportunity to not only explain the gaps in care , the impact of this gap on member’s health, but also what services are needed to close the gap, the costs and the right providers to help close the gap.
Care Plan Adherence
The adherence to the plan of care is important in improving health outcomes and reducing overall cost of care. Start with a proactive reminder, and follow-up with calls to determine root causes and identify reasons for non-adherence. The overall approach should be to inform, educate, and assist members with adherence challenges.
ER is expensive. A number of visits to ER are unnecessary or avoidable, and majority of such visits are taken by a small segment of members. Lower back pain alone results in 2.6 million ER visits a year. Identifying such members and helping them locate in-network providers in alternative cost-effective setting such as remote physical therapy can reduce costs for employers as well as employees. You can use this touch point to educate them on appointment scheduling, video visits, nurse line etc.
Appropriate care transition from one setting to another can have a significant impact on employee’s understanding and compliance, readmission status, and overall satisfaction. It should however be done in a timely manner (within 48 hours of discharge) to ensure the continuity of care.
We understand that most benefit teams are simply not naturally wired to think about the member’s journey through out the year. For teams that master it, the reward is cost reduction, better outcomes, higher employee satisfaction and loyalty. It is well worth it.