With rising consumerism in US healthcare, payers are striving to set up strategies to foster frequent and effective engagement from their members. PHM, Wellness Management, Network Management, etc. aim to address specific business objectives but are only pieces of the complete solution picture. Responsive and immersive engagement is a key determinant in achieving profitable retention and ambitious acquisitions.

Payer organizations are motivated to streamline effective communication between the payer and the member for collaborative care decisions – while making the revenue cycle more member-centric.

Why Focus on Member Engagement Now?

A paradigm shift in the context needs to be complemented with a shift in the payer mindset.

Regulations
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The Interoperability and Patient Access Final rule by the CMS directs payers to provide health information access to members, driving better care decisions.

Member Expectations
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Payer organizations must come forward with a user-centric engagement strategy that matches members’ expectations.

Evidence Driven Decision
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Technology and tools that empower payers to share health information with members are affordable, allowing better care decisions via accurate evidence.

PHM Programs
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Leverage clean data to drive effective surveillance and preventive care programs.

Quality Outcomes
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With informed care decisions, members spend less time in hospitals’ care, reducing payer resources spent on them, thereby improving payer outcome quality.

Competition
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Payer organization must match their member engagement strategies to retain their member by staying ahead or at par with their competition.

Demystifying Member Engagement

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Source

Health & Rx Claims, Enrollment, Case & Contact management, PHM, Provider Networking, Marketing/Sales

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Health

Care Gap Identification, PHM & Med Adherence, Evidence-based Decision, SDOH, Preventive Care, AWV, HRA

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Engagement

Coherent Channels, MX, Feedbacks and Complaints, Gamification, Renewal Reminders with Comparison

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Actors

PCP, Care Manager, Enrollment Specialist, CS, Network Specialist, Claims Ops, Sales/Marketing, Compliance & Legal

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Standards

IAM, Security and Consent, Big Data, Sentiment Analysis, RPA, UI/UX, FHIR/HL7, AI/ML

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Platform

Portals, Mobile Apps, Medical Devices, E-mails, Surveys, Chat-bots, Events, SMS, Wearables

Number of Communication Channels

Number of Communications per Channel

% of Member Population engaged in each Channel

Rate of Actions performed by Members

Cost of Communication per Channel

Engagement Rate per Member

Time spent on Mode of Communication

Member Retention Rate

CSAT and NMPS

Number of acquisitions by referrals

Reduction in Out-of-Network Claims

Decrease in Contact Requests

Population Health Management Churn Rate

Medication Adherence

Reduction in Claims and Prior Authorization

30-Days Readmission and ER Utilization

Improve Business Through Member Engagement

Through strategies tailored to your context, member engagement solutions can improve member experience, thereby addressing a number of business objectives while quantifying the value contributed.

Improve Member Retention Rate

Engage members effectively for longer, increase payer reviews,
and service scores.

New Member Acquisition

Make a statement with your member satisfaction score and receive a higher number of referrals.

Reduced Operation Cost

Keep members out of hospitals with pro-active actionable health information, reducing PMPM spend.

Accurate Clinical Decisions

Drive evidence-based decisions with the latest and complete information for effective care outcomes.

Efficient Communication

Streamline contextualized content on channels with optimized frequency to improve payer-member collaboration.

Reduce Network Leakage

Enable accurate and timely information access for care teams for better in-network utilization.

How do you get there?

Contextual Personalization

Personalized, relevant communication for members to understand the tasks and outcomes

Immersive UX

Intuitive & interactive experience when searching for information on insurance and health

Real-time Intervention

Pro-active interventions to aid care decisions instead of reactive, lagging analytics

Metered Efforts

Avoid over communication and reduce confusion in members by providing targeted communication

Integrate Wearable Devices

Monitor member health and share visualizations of outcomes with members

Omni-channel Engagement

Crisp communication through multiple channels, to acknowledge feedback, and improve on them

How do you get there?

Contextual Personalization

Personalized, relevant communication for members to understand the tasks and outcomes

Immersive UX

Intuitive & interactive experience when searching for information on insurance and health

Real-time Intervention

Pro-active interventions to aid care decisions instead of reactive, lagging analytics

Metered Efforts

Avoid over communication and reduce confusion in members by providing targeted communication

Integrate Wearable Devices

Monitor member health and share visualizations of outcomes with members

Omni-channel Engagement

Crisp communication through multiple channels, to acknowledge feedback, and improve on them

How do we help in the journey?

Assessment

Align engagement strategy with your business objectives

UI/UX Prototyping

Conceptualizing and designing immersive experiences

Enable Interoperability

Integrate FHIR/HL7/API interfaces with your ecosystem

Actionable Engagement

Develop apps, portals, websites; data-driven insights using KPIs

Let’s Create Exquisite Engaging Experiences

Let’s Create Exquisite

Engaging Experiences

Every transformation begins with an idea and a conversation. You have the former, let’s have the latter now!

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