Passive cost-savings measures have run their course. Limiting networks, inexplanable exclusions and higher deductibles are not effective in reducing costs or improving outcomes on a sustainable basis.
In contrast, active engagement of employees through smart strategy and technology can help generate the improved outcomes and cost savings opportunities that self-funded employers are seeking.
Employee engagement can be improved by starting early and consistency delivering timely, relevant, and personalized communication. This requires a systematic approach of orchestrating touchpoints — a touchpoint being any interaction between the employee and her health plan. The key is coordinating and integrating the touchpoints so that they seamlessly meld together.
Here is a list of 5 touch points longitudinally mapped throughout the employee healthcare journey, that can be leveraged to influence a positive action and changing behavior.
Touchpoint 1: Open Enrollment
Reaching out to members during open enrollment is a great way to start the communication. Your MSK solution provider should be able to offer a concierge service that can promote utilization of high-quality services and providers. Several employers are now offering incentives such as subsidized deductibles or cash bonus for using high-quality care. The concierge should be prepared to explain these incentives along with multiple MSK care options and answer specific questions for each employee.
Letting employees know that they can get rapid access to diagnosis and early management advice from MSK specialists using a phone or a video call can boost early engagement and sign-ups into these programs.
Touchpoint 2: Post-Enrollment
Post enrollment (after the member has signed up) is an opportunity to determine satisfaction and understanding of the plan collateral, design and customer service for future improvements.
Several employers provide an incentive to employees for completing assessments. Your MSK solution provider should be able to use that data to segment the population by needs and then determine the appropriate schedule for follow-up interactions with the members. During this interaction, the provider should be ready to track responses that require timely follow up for members needing additional assistance.
Use the right timing to reach members for preventive MSK care. Calls scheduled on the employee’s birthday can be very effective.
Touchpoint 3: Eligibility and Prior Authorization
Ask your MSK solution provider to have a system that can leverage data from eligibility, benefits inquiry or prior authorization transactions. For example, if an eligibility request comes from an orthopedic surgeon, the system should be able to connect the past claims, diagnoses to this request and predict what services an employee is likely to consider in near future. This knowledge can be used to push information directly to employees’ smartphones and tablets about conservative treatment options (such physical therapy, chiropractic care, or a cortisone injection) or about this provider’s cost and quality. These types of timely interactions can promote informed conversations with their doctor at the time of service.
Touchpoint 4: ER Visits
ER is expensive. A number of back or neck pain related visits to ER are unnecessary or avoidable, and majority of such visits are taken by a small percentage of members. Your MSK solution provider should identify such members and help them locate providers that can provide the care they seek in a timely manner. This touch point should also be used to educate members on telehealth triage service, digital MSK programs, etc.
Touchpoint 5: Care Transition
Your MSK solution provider should work alongside acute and post-acute staff to ensure the members receive the optimal post-acute care, get discharged to the most appropriate setting, resulting in lower costs and higher quality outcomes. Providing a concierge-like experience to guide members through post-acute care increases member engagement.
Most third party plan administrators are not wired to engage consistently with members throughout their health journey. For employers who are ready to invest in the alternative – the reward is cost reduction, better outcomes, and higher employee satisfaction. It is well worth it.
Sprite Health is focused on transforming musculoskeletal care by identifying employees with MSK issues, guiding them to the highest quality care and engaging them throughout the care journey. Our turnkey solution (built on AI driven technology, a high-touch concierge service and a curated MSK network) delivers better health outcomes while significantly lowering costs for employers and employees.