How Engaging Members Throughout Their Lifecycle Improves Health Outcomes and the Bottom Line

April 23, 2019 Emmet O'Gara

Chalk it up to human nature. We love the action and drama of fast, focused and expert care, the kind that saves lives in the crucial 60 minutes after a serious trauma injury. I call it the “golden hour effect.” To demonstrate what I mean, look no further than the evening television lineup of top-rated shows set in hospital emergency departments.

Healthcare payers have borrowed this concept when they refer to the member enrollment stage. That’s when they are able to establish a connection to a new member to gather self-reported data.

While both concepts are valuable, it’s important that providers and payers take the next big step to look beyond the quick results of a golden hour. The broader perspective reveals an incredible opportunity to improve the health of individual members and populations, which also halts escalating healthcare costs.

From Golden Hour to Golden Era

Let’s shift our thinking from the immediacy of trauma care or new member intake. Instead, think about the reality of where poor health and the cost of healthcare are growing: the increasing number of U.S. consumers who, regardless of their health, have little or no meaningful contact with the healthcare system. We know that many of these individuals have existing conditions that are undetected, and even if they are known, often go unmanaged and untreated.

The reality is that many of these consumers will ultimately require emergency or chronic care management when their condition worsens. Because they have become seriously ill, an inpatient stay and extensive treatment and prescriptions are likely. Their health compromised, they will now be receiving the most expensive care possible.

But many of these poor outcomes can be avoided. For consumers who have health plan coverage, a far better approach is to engage these plan members from enrollment throughout their lifecycle, adjusting the types of outreach to their individual risk level and health status. Healthy individuals may need reminders and education about screenings and well visits. Rising risk members may require specific engagement on how to avoid becoming unhealthy. And those dealing with chronic conditions need more focused care management,

The goal is to get members to take action on their own behalf – to engage with the healthcare system – in order to continuously move to a healthier status. This may involve making and keeping healthcare appointments, adhering to medication, avoiding risky drug combinations, or a host of other actions.

This type of long-term cycle approach has been proven effective, but there are some members who will not be impacted by these engagement practices alone. Providers and payers must address other obstacles such as behavioral and socio-economic conditions that may block access to care. These conditions, such as poverty, lack of transportation, inadequate housing, language barriers and other social determinants require an approach that clears a pathway to enable care.

There are also challenges in maintaining steady and reliable contact with individuals who may be extremely mobile, frequently change residences, are technologically challenged, have physical handicaps or experience other communication or life circumstance barriers. Like socio-economic barriers, these factors must also be addressed for a successful engagement program.

What’s Being Done

Getting disconnected members engaged in the healthcare system is a challenge that is being met head-on through new technologies and analytics. Where implemented, they are providing tremendous benefit – but we need wider adoption. Examples include:

  • Unique predictive analytics that can detect which individuals in a member population are most likely to develop worsening health conditions in the future, before they require extensive health services. Intervening on behalf of these rising risk members represents some of the greatest opportunities to maintain and improve a population’s health.
  • Aggregated healthcare, demographic and other consumer data paired with artificial intelligence can now identify people at risk due to social determinants. Tailored engagement solutions can then help these members get the transportation, housing and food they need, allowing them to take action on their own healthcare, and become healthier.
  • Member engagement strategies that leverage behavioral science, cultural consideration and marketing techniques are making inroads with hard-to-reach consumers. Standard “robo” calls, emails or physical mail will not reach members who are transient or have other communication challenges. Member communications that are tailored to an individual’s circumstance and preferences are most effective. Time of contact, mode of contact, language, positioning and many other factors all come in to play, and can facilitate breakthroughs in engagement.

I doubt we will someday watch thrilling Netflix programs about keeping prescriptions up to date or the importance of showing up for medical appointments, but it is time to bring the longer-term play – the golden era concept – into effect when managing our population’s health.

HMS is taking the long-view on member engagement – identifying rising risk, addressing social determinants and tailoring communications to individuals. What approaches are you taking improve your members’ health?

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