In 2021, I’m writing a series of blogs to illustrate how health plans are using Geneia analytics to solve pain points and meet their goals. The first one, COVID-19: Putting analytics into action, illustrates how health plans are using Geneia’s enhanced ID and strat framework to identify and engage members who have deferred preventive and chronic disease care during the pandemic and also are at high risk for COVID-19 severe impacts.
The Member Engagement Dilemma
People expect to be known by the healthcare system, and interacted with in the ways they prefer. They know it’s possible because that’s how their bank, their shoe company and Amazon interacts with them.
Yet, health plan member satisfaction lags other industries, even more so in the pandemic. “60 percent of privately insured U.S. health plan members say they were not contacted by their health plan with guidance or information related to COVID-19, and nearly half (48 percent) say their health plan has not shown concern for their health since the pandemic began.”
JD Power finds “proactive efforts by health plans to engage members drive significant improvement in overall customer satisfaction. For example, when a health plan helps members keep out-of-pocket costs low, the average overall satisfaction score is 819, which is 152 points higher than when no such effort is made.”
Health plans have evidence member engagement initiatives improve the Triple Aim. As we recently shared in Geneia Case Study: Next-Generation Identification, Stratification and Engagement Improves Triple Aim, a health plan using Geneia’s next-generation identification, stratification and analytics combined with advanced member engagement by its own case management team realized estimated cost savings of more than $7,500 per member. For every $1 in administrative cost spent on the case management program, the health plan saved more than $3 in healthcare costs.
Engagement improved too. Two-year results show:
- Referrals increased 285 percent
- Open cases rose 71 percent
- Member engagement increased 289 percent
Another health plan leveraged NextHealth Technologies’ advanced analytics platform to prove the value of its member advocacy program and demonstrate a reduction in avoidable emergency department visits and costs. In short, the plan’s concierge initiative improved member health outcomes and costs:
- ED visits declined by 8 percent and costs by $8 PMPM
- Avoidable ED visits decreased by 5 percent and $0.35 PMPM
- Well visits climbed by 8 percent
- Telehealth visits increased by 3 percent
- Doctor visits jumped by more than 200 percent.
The importance of engagement to members and the connection to member activation and health outcomes helps explain why health plans are increasingly facing competitive threats from concierge service providers who sell their member advocacy services to self-funded employers.
Putting analytics into action to improve member engagement
Goal: Integrate member data to deliver actionable insights that enable a health plan member services representative to identify potential issues and opportunities for education and programs at the first point of contact.
Emily is a member services advocate at Allegiant Health Plan. 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.
Lucy*, an Allegiant Health Plan member, calls into the plan. As she does, Lucy’s information is presented up to Emily. In addition to seeing standard eligibility, demographic and claims information, Emily can readily see member alerts including rising risk, open gaps in care information for blood pressure and adult BMI screenings, as well as healthcare utilization information. Emily can also see that Lucy has prediabetes. All at the first point of contact.
In light of the alerts and Lucy’s diagnosis of prediabetes, and the fact that Lucy has not seen her PCP in over a year, Emily advises her to schedule an appointment with her primary care physician.
Emily can also see the recommended next best action is for Lucy to participate in a prediabetes prevention program. She talks to Lucy about how the program can help her avoid progressing to diabetes. Lucy agrees to enroll the program, Emily creates a referral to the program and is able to perform a warm transfer to the care team to speak with Lucy.
That’s Geneia analytics in action to improve and personalize member engagement. It’s also a critical building block to the health plan digital front door strategy. To learn more, download our white paper by clicking here.
*Lucy is fictional and not intended to represent any specific person. This information is provided for illustrative purposes only.