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
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
Payer organizations must come forward with a user-centric engagement strategy that matches members’ expectations.
Evidence Driven Decision
Technology and tools that empower payers to share health information with members are affordable, allowing better care decisions via accurate evidence.
PHM Programs
Leverage clean data to drive effective surveillance and preventive care programs.
Quality Outcomes
With informed care decisions, members spend less time in hospitals’ care, reducing payer resources spent on them, thereby improving payer outcome quality.
Competition
Payer organization must match their member engagement strategies to retain their member by staying ahead or at par with their competition.
Demystifying Member Engagement
Source
Health & Rx Claims, Enrollment, Case & Contact management, PHM, Provider Networking, Marketing/Sales
Health
Care Gap Identification, PHM & Med Adherence, Evidence-based Decision, SDOH, Preventive Care, AWV, HRA
Engagement
Coherent Channels, MX, Feedbacks and Complaints, Gamification, Renewal Reminders with Comparison
Actors
PCP, Care Manager, Enrollment Specialist, CS, Network Specialist, Claims Ops, Sales/Marketing, Compliance & Legal
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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