Applying Patient-Centered Care Principles in the Payer Market

February 6, 2020 HMS

In the healthcare sector, the patient is at the center in hospitals, clinics and physicians’ offices. Many of the principles of patient-centered care can be extended to the health plan setting. In plans, we often refer to “member engagement” and how patients/members can be empowered to play a role in improving their well-being by closing gaps in care.

Integrating Patient-Centered Care Concepts into Member Interactions

A guiding principle of patient-centered care is that patients are partners with healthcare providers. Imagine what a world might look like where this is the case:

  • Care would be coordinated, accessible and affordable
  • Health plans and members would operate with mutual respect; health plan processes would respect member preferences and values, and
  • Members would feel like they were an active part of their own care team.

This model of interaction could have a positive effect on both members and health plans alike. Better communication and coordination would encourage members to participate in their healthcare, receive preventive care, and reduce healthcare expenses. In addition, members would be more likely to be satisfied with their health plans and more likely to renew with them.

 A Member-Centered Approach to Year End Quality Initiatives

Before the end of the year, health plans often launch member outreach programs focused on gap closure in an effort to boost quality ratings. Best practice suggests reaching out to members via multiple modes of communication, such as phone, text message and email.

To make these year-end outreach campaigns more consistent with the foundations of patient-centered care, communications must be personalized. Personalized messages do not simply mean addressing a member by their first name, although research does show that including a person’s name in the email subject line sees an increase in open rates by 82%.

Personalization extends to member preferences, culture and values. Why, for example, would members want to get a breast cancer screening, adult preventive care visit or comprehensive diabetes care appointments?

Just as members have unique communication preferences, they also learn in different ways. Health plans may want to consider taking a culturally adapted approach to develop a set of educational resources that appeal to diverse learning styles. Some members may learn better through printed materials, while others may prefer brief online videos. Patient-centered care offers decision aids that help individuals make informed choices. Directing members to educational resources and encouraging members to ask questions can deepen the relationship between the member and the plan.

Lastly, we want our members to have easier access to better care. As healthcare providers and payers, we want to be sure that we’re delivering the right care at the right time. We have an opportunity to reach out to our members in the way they prefer, to give them information and tools to make informed choices, and we can do it with a smile and a desire to be of service.


To learn about how health plans can enhance member engagement and improve quality ratings, download our white paper — Charting the Course for Quality Improvement: Six Strategies for Boosting Quality Scores at Year-End.

Download White Paper

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