3 Steps to Enhance Health Plan Member Engagement

With hundreds of millions of Americans to support and limited resources to do so, the U.S. healthcare system is overwhelmed—and though many health plans have made substantial strides in creating a more personal experience that addresses consumers’ unique health needs and preferences, it’s still quite a difficult undertaking. 

In a panel at World Health Care Congress 2021, leaders from Blue Cross and Blue Shield of Vermont, BlueCross BlueShield of Tennessee, Brighton Health Plan Solutions, IDC Health Insights, and Castlight discussed how to leverage technology and innovation to make healthcare feel more personal.

Ultimately, these three steps can lead to more members engaging with the right care at the right time—and, in turn, result in better health outcomes and decreased medical spend.

3 Steps to Building an Engaging, Optimized Member Experience

1. Leverage Your Data for a Deeply Personalized Experience

Each individual’s health journey is unique, so personalization is critical for member engagement—but it becomes incredibly challenging to execute at scale. Fortunately, data science techniques like machine learning and predictive analytics provide us with the tools to deliver a personalized health and wellbeing experience for all members.

Leveraging diverse claims, clinical, wellbeing, socioeconomic, and member interaction data to develop a 360º member profile can provide critical insights into members’ health and wellbeing needs.

Personalization engines can ingest this data, segment members by their clinical or wellbeing needs, then provide proactive, relevant recommendations for care, programs, and content that are tailored to the individual, thus helping them better manage their personal health journey. 

One way Castlight uses personalization, for example, is to help support individuals who may experience barriers to care driven by social determinants of health (SDoH). By analyzing member data—including claims and self-reported gaps in care—and national geographic data such as poverty rates, food deserts, and provider scarcity by zip code, we’re able to better understand the barriers certain populations face due to socioeconomic factors. Then, we conduct personalized outreach aimed at connecting these individuals to low- and no-cost resources that can help them overcome the SDoH challenges they may face.

2. Provide a Full Healthcare Ecosystem and Empower It with a 360º Member View

Member health journeys span digital, high-touch, brick-and-mortar, condition-specific point solutions, and more. The common theme across care providers and programs? Each one is interested in more holistically understanding the whole member—i.e., understanding their current needs and unique clinical history—so they can provide the best care possible. If centralized, two-way data exchange is enabled between touchpoints across the healthcare system, we can maximize the value of each interaction for a more cohesive, impactful experience.

For example, claims data and member behavior may reveal that a member is suffering from anxiety or depression, and health benefits eligibility data may show that the member has access to free mental health resources through their carrier or employer. Leveraging this information, the plan can conduct outreach to the member and encourage them to start using these mental health resources. With two-way data integration, the platform—whether it’s the digital mental health provider or a health navigation solution—sends the member’s activity back to their profile to power continued engagement and inform future interactions with other parts of the healthcare system.  

3. Provide Digital and High-touch Engagement Channels for an Experience that Meets Members on Their Terms

Many prefer to engage with healthcare digitally, just as they manage their finances or social networks. And today, more than ever, a larger portion of the population is becoming more comfortable managing their health digitally and receiving care virtually—a trend that has only sped up with the pandemic. Offering high-quality, consumer-friendly digital tools that help people navigate their health is a great way to engage more of your members.

At the same time, healthcare can be confusing, frustrating, and overwhelming—especially for those who feel sick, are dealing with a complicated issue, or lack access to or don’t feel comfortable using technology. Providing high-touch member support to complement digital options goes a long way in meeting members where they are, through their preferred channel—whether that’s phone, text, email, or chat.

But the key to a seamless experience that combines digital and high touch is maintaining personalization across channels. Whether engaging digitally on their app or interacting with member support by email, phone, or chat, members should always receive recommendations designed just for them. An intelligent backend powering both your digital experience and your member support team (plus their CRM system) can help you deliver a consistently personalized, engaging experience for your members.

Looking Forward

It’s no secret that healthcare is changing quickly—even more so due to COVID—so agility is key. To maximize engagement and impact, stay close to your members’ evolving needs and preferences. A flexible, scalable operating system will help you innovate quickly and adjust with ease—and, in turn, lead to better member experience and improved health outcomes.