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Improve member engagement using lessons from clinicians

Jitesh Rohatgi,
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In the U.S., there is a disconnect between patient satisfaction from care providers and overall member satisfaction from health plans.

Doctors, nurses, therapists, hospitals, laboratories, researchers, pharmaceutical manufacturers, pharmacy benefit managers, and payers are just a few of the entities that make up the complex and interconnected U.S. healthcare system. Patients who navigate through this system in search of care usually find both comfort and frustration. Comfort in the form of skilled treatment from physicians, nurses, and other professional medical staff, and frustration in the form of paperwork, processes, and explanations of coverage.

The U.S. Centers for Medicare and Medicaid Services sponsors the U.S. Hospital Consumer Assessment of Healthcare Providers and Systems survey (CAHPS®Hospital Survey), which measures patient perspectives on a range of hospital care topics, including communication with doctors and nurses. The 2017 survey shows that more than 77% of patients feel doctors and nurses listen to them and communicate to them with courtesy and respect.

On the payer side, the J.D. Power 2018 Commercial Member Health Plan Study concludes that overall, member satisfaction with health insurers remains low, compared to other industries, and points out that “communicating with members at every touch point, with a focus on better equipping members to navigate the healthcare system” is an essential challenge that health plans must address. “The key is effective communication.”

To improve member and patient satisfaction, health insurers and payers should consider taking what works in the clinical setting and apply it to the business setting.

Personalized communication is the key touchpoint in both clinical (hospital/doctor’s office) and business (customer service/call center) settings.

For example, medical professionals are trained to engage in personal, one-to-one conversations geared toward collecting detailed information to provide individualized care that will help prevent readmission. Health insurers can similarly deliver a better level of customer service that may also help reduce call center callback rates by providing more contextual, personalized engagements.

This means payers need to go beyond basic administration, like solving billing and coverage concerns, and taking a proactive approach to member engagement with information related to each patient’s unique needs. Whether the topic is cost of care, understanding how a plan works, or the latest health research and innovations, information tailored and localized to the member’s plan and specific health needs helps advance the relationship with each individual member.

Focus on building long-term member relationships – a “continuity of care” for customer service.

Just as continuity of care can improve outcomes for patients in a clinical setting, increased member engagement drives better outcomes for the member, and higher retention and lower costs for the payer. Again, to do this you need to be able to analyze the member’s context to determine relevant messages and actions; provide timely, contextual communications that adapt as member health needs adapt; and deliver consistent, interactive conversations that can start and end in any channel.

The benefits to this proactive, personalized approach are:

  • A more consistent and valuable member experience
  • Higher member engagement
  • Higher satisfaction ratings
  • Opportunities to increase value
  • Reduced costs

Start by adding personalized intelligence to any step in the member journey.

Use the data you have to become more interactive and real-time relevant. An intelligent decisioning tool can help you analyze each member’s history and foresee their needs. It can also help you know when the time is right to introduce members to new programs or services. Most importantly, leverage smart technology to deliver the same type of valued, personal, empathetic conversations that your members experience in a clinical setting.

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Défi: Service client Industry: Santé Thème: Expérience client personnalisée Thème: IA et prise de décision

À propos de l'auteur

Jitesh Rohatgi, Pega’s global director and healthcare/life sciences principal, has over 15 years of experience advising life sciences and healthcare organizations on the most effective use of CRM, MDM, and AI technologies to improve clinical safety and patient care.

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