HealthApril 03, 2024

Better care management: Using evidence-based medicine to improve member experience

Evidence-based medicine helps care management teams develop personalized member experiences that enhance adherence, satisfaction, and health equity and accessibility.

New approaches for payer care management

Payer care management is a pivotal component of the member experience — and many payers are sitting on untapped opportunities to improve outcomes, reduce mistrust, and build healthier relationships with members through targeted use of healthcare educational materials.

The key to this effort is to think beyond generic education and instead look at member education through the lens of evidence-based medicine. This perspective is critical to shaping individual member experiences while simultaneously positioning payers as active drivers of accessibility, equity, and personalization.

Enhancing the member experience through strong payer care management

Payer care management is a dual-faced effort, balancing the responsibilities of fiscal diligence and member-centric care. Evidence-based medicine is a powerful tool in producing members who are informed stakeholders — active partners in improving their health and supporting optimal outcomes.

The most effective evidence-based educational materials start from the perspective of member motivations. One payer has used surveys of providers, including ambulatory, outpatient, fee-for-service, and home heath, to assess how beneficiaries were experiencing access to care. You can apply similar tactics to understand patient access to healthcare educational materials, patient expectations, and how they influence the member experience.

Building trust through evidence-based healthcare educational materials

Payers sometimes have significant ground to make up in shifting member perceptions, and evidence-based inputs can help bridge this gap.

Understanding patient mistrust

Some patients will struggle to achieve optimal levels of participation without trustworthy healthcare educational materials. This is especially true for members who are high- or rising-risk or who are from demographics with a history of challenging experiences with the healthcare system.

Fundamentally, distrust is a belief that patients or members should question motives and view an entity’s action with suspicion. While this is not unique to any racial or ethnic group, histories of discrimination, racism, and unethical treatment are important to note for any payer that wants to foster trust. Certain groups, including African Americans, Latinxs, the LGBTQA+ community, Native Americans, and Asian Americans carry with them long histories of inferior quality of care even when holding comparable levels of insurance and access as more privileged groups. These groups’ experiences will influence their perception of trusted content, how they relate to medical experts, and how they receive information.

Evidence-based medicine is essential in engaging these communities. Care management teams need to be able to offer digitally accessible health and medication information that is transparent, consistent, and rooted in verifiable sources that skeptical members and patients can respect. It also must be simply and clearly presented to support understanding and foster treatment plan adherence and trust.

Effective health education materials should also be diverse, equitable, and inclusive, with imagery representing a wide varieties of members, available in a variety of languages, and able to connect with diverse life experiences and backgrounds. These materials should act as bridges to connect patients with critical knowledge and support care manager efficiency, freeing them up for higher-value tasks.

Creating credibility with evidence-based content

Allison Combs, Head of Product, Payer Clinical Effectiveness at Wolters Kluwer, Health, highlights the challenge of finding an effective way to communicate that information is both trustworthy and actionable: “It’s a different type of touchpoint and one that truly supports a full circle of education and best experience scenario for a member that is both actionable and trustworthy.”

Payers can build credibility by relaying the fact that the information patients are receiving is based on thoroughly researched and proven guidelines — guidelines that align with their goals, provider recommendations, and the latest scientific evidence.

A blueprint for effective care management integration

To integrate evidence-based information into care management practices effectively, plan leadership will need to lay the groundwork as early as possible.

Segment your members

As you build out your evidence-based education plans, consider segmenting your members based on psychographic factors. This will help you identify and target educational efforts, focusing on patients who will benefit most from evidence-based medical information. It can also help you find those who are at inflection points in their health journey where this type of intervention can be the most helpful in improving outcomes and experience.

Review healthcare educational materials

After identifying the patient profiles and populations that can realize the most benefit from evidence-based content, consider reviewing existing educational materials for alignment with recent findings and clinical practices. Evaluate points including:

  • Update frequency: How often your educational material is updated and how it aligns with the speed the evidence is emerging.
  • Clinical review: How often your content is reviewed and adjusted to align with clinical best practices.
  • Feedback loops: Whether and how content creators are engaging proactively with users to understand and incorporate feedback, including personalization options like what a member wants to learn and how they want to receive it.

Prioritize responsiveness

Building responsiveness into your content feedback loops will be critical. Medical research evolves incredibly quickly today, putting the responsibility on care managers to update materials on an almost constant basis. For managers that are already busy, technology can be incredibly helpful here, enabling real-time updates and ensuring all members have access to the most current data possible

Incorporating analytics

Payer leadership should also keep an eye out for opportunities to leverage robust data analytics to flag areas of member need or interest. These can fine tune the pace and content of materials and ensure that members feel acknowledged and heard.

Moving care management forward with member engagement

As payers face more complex care management challenges, evidence-based medicine continues to prove itself as an invaluable basis for an experience that empowers today’s members and aligns stakeholders across the healthcare landscape. To learn more, download the whitepaper, “Filling the healthcare education gap: A care management opportunity."

Download the Whitepaper
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