Not your father’s Oldsmobile: Member advocacy is evolving

October 02, 2018
Molly Gallaher Boddy, Strategy Analyst, Market and Competitive Research


Smiling black woman talking on a head set

As healthcare payers, technology and retail vendors consolidate or merge to capture the enormous opportunity available in spaces such as employer health and Medicare Advantage, there is a heightened market interest in how healthcare must shift to become more customer and technology-centric, resembling the model used in other industries. While healthcare vendors are certainly investing to make their portfolios digital and consumer focused, healthcare nonetheless remains unique. Patient-member advocacy and engagement, coupled with technology platforms, enhance the member experience and enable a holistic, higher-touch model of care that ultimately lowers healthcare costs and improves outcomes.

Member advocacy programs - which arm patients, employees or health plan members with information about their care and health coverage, guiding them through the care continuum and making them stakeholders in their own health - as well as engagement and clinical services enhance existing customer investments in digital health tools. While member advocates and coaches are sometimes clinicians (or not, depending on the business model) they are distinct in that they are not only members of the care team, but instead a direct link between the care team and the member. Member advocacy has long been offered by large payers, but today’s market necessitates an approach to member experience that extends beyond typical disease and case management services. As healthcare M+A activity proliferates and healthcare companies look to make the digital patient or member experience more personal, member advocacy programs are receiving fresh interest as a necessary component of updated member engagement strategies.

Though a number of vendors have invested in member advocacy, a few key areas of application stand out:

Primary Care

Primary care is ripe for disruption, as vendors like Apple have found through attempts to bring concierge models of care to their employees. Technology that enables patient access to health records, self-service tools and engagement helps consumers get the most out of their time with physicians while enhancing their commitment to any necessary follow-up appointments or actions. Still, while vendors like Iora Health have invested in such technology for the primary care space through its care platform, personalized service to patients remains central to achieving market differentiation.  The vendor emphasizes a person-focused approach to primary care, led by health coaches and dedicated advocates who keep patients at the center of the experience. Iora Health’s approach seems to be resonating with the market, with the vendor recently closing a $100 million funding round.

Medicare Advantage

Personalized clinical, engagement and advocacy tools are also crucial to market differentiation in the Medicare Advantage space, as the 65+ market is moving towards a higher-touch care model that provides assistance in navigating benefits around Rx, home care and a vast array of other services that may take place across clinical and retail health settings. Remote patient monitoring, for instance, is a major area within the 65+ market where technology and person-led clinical services complement, as monitoring technology requires skilled clinicians who engage with members to truly drive improvements from any collected data.

Remote patient monitoring reduces medical spend by 50 percent

For this reason, technology leaders are recognizing the need for personalized services that complement digital tools to compete in the Medicare Advantage space. Google’s parent company Alphabet recently invested in health insurer Oscar Health to help it enter the Medicare Advantage space, for example. In addition to offering health plans, Oscar Health emphasizes a concierge health model. Members have access to concierge teams that help them not only in understanding their benefits and billing questions, but in areas such as condition management and care coordination. Services that connect patient care across the healthcare continuum will be especially beneficial to Medicare Advantage members with complex health concerns: even though investments in technology are crucial to Oscar Health’s success, a concierge, personalized care model may be what ultimately helps drive individual Medicare Advantage patient results—and lower costs—when used alongside that technology.

Employer

One final area where a combination of technology and high-touch services work in tandem to improve consumer healthcare experiences is within the employer market. As referenced above, vendors like Apple are taking matters into their own hands, offering employees and dependents personalized care at specified locations. And, with employers responsible for growing healthcare costs, groups such as the National Business Group on Health are calling attention to the innovative ways in which large employers are controlling healthcare costs. Vendors offering employee advocacy programs will benefit from solving these types of employer health challenges.

Accolade, for example, provides employers with health assistants that help their employees understand their plan, benefits and billing, as well as help them access clinical services and communicate with care team members. While Accolade recently closed a funding round to bring its total investment to roughly $200 million, perhaps the biggest harbinger of market needs for the type of services Accolade offers comes from an announcement that Amazon, Berkshire Hathaway and JP Morgan & Chase selected Jack Stoddard as chief operating officer of their joint healthcare venture. Stoddard’s experience includes time as the chief operating officer and chief strategy officer at Accolade, suggesting the joint venture participants recognize the need to balance a technology-centric approach to healthcare with high-touch care coordination and patient advocacy services.

All of this market activity indicates that, in healthcare, digital investments that prioritize customer experience must be balanced with appropriate advocacy, engagement and clinical services that make any results gained from digital tools actionable to patients and members. Unique among its competitors because of its clinical staff, Geneia is already empowering Medicare Advantage and employer clients to engage in more personalized approaches to health: our technology is an enabling tool, but our trained clinicians are the true customer guides.

Stay tuned for more updates on how we are using our clinical talent and solutions in tandem in the near future. In fact, the current market need for enhanced member advocacy and engagement is an important part of the reason we have chosen to partner with Salesforce Health Cloud. As a CRM vendor, Salesforce’s main priority is the end-customer experience and the collection of actionable customer data. As we bring greater integration to this end-consumer focus and our existing clinical services and population health technology, our payer, provider and employer clients look forward to an even more personalized and on-demand approach to overall health.


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