Digital Front Door: The Health Plan Perspective | Geneia

Digital Front Door: The Health Plan Perspective

April 28, 2020
Heather Staples Lavoie, President & Chief Executive Officer


Data integration capabilities and analytics now allow all health plans to create a digital front door

Meet Emily. She’s a member services advocate at a health plan that’s implemented a digital front door strategy. Until recently, her job was simply to respond to member inquiries. Now she is charged with resolving the member’s stated need at the first point of contact as well as educating and engaging members in care management. That means she needs holistic member information and direct access to care management resources.

Meet Emily and Lucy

A member, Lucy, calls into the health plan to determine if she has a gym benefit. As Emily answers the call, detailed information about Lucy is presented on her screen. In addition to seeing eligibility, demographic and claims information, data that is commonly available to health plan service agents, Emily can also see a broad range of member alerts and important contextual information. In Lucy’s case, she has several alerts: her risk score is rising, she has open care caps for blood pressure and adult BMI screening, she is prediabetic, and she has a worrisome pattern of emergency department use. Emily can readily see all of this information at the first point of contact.

After gaining a quick, yet strong, understanding of Lucy, Emily quickly checks her benefits and determines that she does have access to a gym benefit. Lucy’s son and daughter do too.

Emily takes advantage of Lucy’s call to quickly review her alerts with her, including her prediabetes diagnosis and recent clinical encounters, which were at the emergency department. Emily initiates a discussion with Lucy about her use of the emergency department and learns that Lucy’s ED visits were for the flu and a laceration. Emily educates Lucy about the advantages of using urgent care for such health issues.

Lucy’s Next Best Action

Emily can also see the recommended next best action is for Lucy to participate in a diabetes prevention program. She talks to Lucy about how the program can help her avoid progressing to diabetes. Lucy agrees to enroll in the program. Emily creates a referral to the program and the care team is notified about Lucy’s participation, all from the same member services screen, and Emily is able to perform a warm transfer of Lucy to the care team, passing along her complete information with the referral.

Once she has enrolled her in the diabetes prevention program, Emily puts Lucy on an automated engagement journey to enable her participation. The journey begins with a personalized email, and depending on Lucy’s communication preferences, she’ll receive additional emails, texts and/or follow-up calls.

Digital Front Door Results

Members like Lucy want healthcare organizations to know them and proactively engage with them just as banks, telecommunications companies and online retailers do. Patients have some sense that this level of personalized care is, in fact, possible. Just think about what Amazon and Alexa know about you:

  • Your music playlist and preferences,
  • What you’ve searched for on Amazon, Zappo’s and Diapers.com,
  • When packages are expected to arrive at your house and more importantly, what’s inside the boxes,
  • What time you get up and go to bed.

And then think what Amazon can surmise about you with all of this information. Certainly your music listening behavior provides insight into how often and for how many minutes you exercise. The tone of your voice, coupled with other information such as your music choices, communicates your mood, and over time, likely some insight into your mental health. Perhaps your health status and conditions too, especially if you order cold medicine, diabetic supplies or blood pressure medications from Amazon or its subsidiary PillPack.

Member expectations

Improving Health Plan Customer Experience

Meeting members’ expectations and resolving their issues at the first point of contact has a very direct impact on customer experience. As someone who has worked in and around health plans for most of my career, I know better than most that it’s a rare day when one hears a compliment about a payer. Forrester Research’s Customer Experience Index, which “measures how successfully a company delivers customer experiences that create and sustain loyalty,” validates my experience.

In 2016, health plans ranked in the bottom five of all industries, just above the airlines. While the health insurance industry had one of the biggest improvements in Customer Experience Index from 2018 to 2019, significant challenges persist.

For starters, the best health plan performers scored in the mid to low end of the ok category (65-74 out of 100), and the rest fell into the poor category (55-64). Even more tellingly, “Only 56% of customers feel they can get help when they need it and that employees know how to solve their issues quickly.”

Only 56% of customers feel they can get help when they need it.

Interestingly, Kaiser Permanente has scored number one among health plans for many years. Of all the health insurers measured, “It had the highest percentage of customers having effective and emotionally positive experiences and tied for easiest experience with number two Humana.” Forrester posits, and I agree that,

Kaiser Permanente is an integrated delivery network (IDN) that provides both healthcare services and a health insurance plan. This gives it an advantage over most of its competitors – allowing for more control throughout the entire customer life cycle and for increased transparency with customers and employees.

In other words, Kaiser is poised to have effective and holistic data integration that enables everyone in the organization to know the member and be able to easily access their healthcare opportunities and needs as well as their preferred method of communication.

Until now, health plans like Kaiser have had a distinct advantage – the single or digital front door. The evolution of data integration capabilities and analytics now allows all health plans to create a digital front door, enabling them to improve member satisfaction, quality outcomes and ultimately costs.


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