Gezondheidszorg20 april, 2023

Payers’ role in improving care and member experience

The shift to consumerism in healthcare has empowered patients to participate more actively and make more informed decisions in their care. Payers have an important role to play in ensuring their members receive the best possible experience that is cost-effective.

According to a survey from J.D. Power, plan satisfaction among commercial insurance members did not change between 2021 and 2022, following several years of steady climb. In this plateau, experts don’t see a warning, but an opportunity for payers to take a lead role in engaging members and rebuilding patient trust in health information.

Establishing member trust: Getting them off to a good start

Payers represent the start of the healthcare journey for many patients. This is because payers have the ability to:

  • Give members the resources to select their providers.
  • Offer access to tools and information to create a more personalized experience for members.
  • Provide a consistent touchpoint throughout the member experience.

“Payers want what’s best for members,” says Allison Combs, Head of Product – Payer Clinical Effectiveness at Wolters Kluwer Health. To achieve that, she explains, payers are focusing on ways to reach more people, be more effective in their outreach, and how to help the people they reach understand their care options and feel comfortable and confident that they are making the right decisions when in comes to their health.

Building member trust at scale through aligned information

The challenge, Combs says, is finding that effective way to communicate actionable information that the average member can relate to and trust. Payers need to further support what a member hears from their provider by “reinforcing” important health information at times when a person is more inclined to listen and pay attention; for example, outside of a doctor’s office, easily accessible on a member’s mobile device. “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.”

“That’s the one thing that Covid did brilliantly,” she says, noting how the pandemic demonstrated our capability to reach larger populations, communicate essential health information, and give access to necessary treatments at scale. “Now, as an industry, we need to turn capability into a scalable, optimized solution so that all populations get what they need.”

How do you provide individual care experiences for your member population?

Combs notes that while members are looking for personalized experiences, payers can’t provide worthwhile engagement by focusing only on individual member needs. The only way to scale effective engagement is to examine patient populations and “try to help enforce and encourage evidence-based medicine,” she says.

“I think continuing down that path we find ways to merge that evidence-based guidance and best practices, especially at subpopulation levels [focused on] convenience with ease of understanding, ease of use, ease of access,” Combs adds.

Another important way to individualize the care experience is through diverse and inclusive content. Taking DE&I considerations into account when producing health information can help members feel seen and represented, and can help build trust and personalize member outreach.

Payers can offer health information with context

Medical content plays a critical role in building trust throughout the patient experience. When patients encounter the same information from their provider, their pharmacist, and a payer wellness portal, they’re more likely to trust it. When information is inconsistent, it’s difficult for them to determine which source is trustworthy and the one to rely on to inform health decisions.

Payers become a more valuable resource when they engage members with health and wellness information that not only helps inform their decision-making but is consistent with the information they receive from medical providers.

“If a member is hearing something from their provider and they’re also hearing the same thing from their payer, that raises trust,” Combs says.

Combs notes that health information from payers should be:

  • Easy to understand and explained in a meaningful way to help members understand the most important points.
  • Presented in context and aligned with their care scenario, so it’s easier for them to consider their options.
  • Clinically authentic so the “underlying science and medicine are consistent and harmonized” with what they hear from providers.

“You’re not just helping members understand what [condition or procedure] they have and what their options are, but you’re also helping to surround them with all the right care options that they need to help make that a reality,” Combs says. “And not everyone needs the same thing.”

Scaling health information for members

As members demand a better care experience, payers have the opportunity to partner with them in their care journey. By providing trusted clinical content that resonates, care management teams can engage with diverse member populations and provide health information aligned with clinical teams.

Download our whitepaper, “Improving the member experience” and learn more about scaling care management and impacting member trust with UpToDate Guide.

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