We offer strategies to better engage with members and encourage them to become active participants in their health.

By Medecision

Member engagement has been a topic for health plan professionals for a long time, yet few plans are operating successful member engagement programs. In May 2020, JD Power published a report with indicators of “a health insurance marketplace that lacks focus on customer engagement, making it ripe for disruption.” And that’s after nearly a decade of discussions regarding how to implement member engagement initiatives!

Part of the problem is a focus on high-level concepts and a failure to get into the details of how to apply those concepts. Consumers do want to be involved in their own care, but plans don’t always take the crucial steps necessary to help them know how to change their behavior. Some plans are finding success, however, both overall and with specific programs.

Understand Engagement—and Then Engage

One of the most important steps in building member engagement is understanding who needs to be engaged and what “engagement” is. For example, an initiative designed like a retail loyalty program, with a goal of reaching the maximum number of members possible, is unlikely to be successful in changing specific behaviors within a particular group of members. The following strategies can help identify the right members, activities and communications methods for a given initiative.

1.    Segment Members

In healthcare, as in so many other industries and efforts, a small number of members likely accounts for the majority of costs. Those who have chronic conditions but are unengaged in their care represent a segment of members who may be motivated to change through a member engagement initiative. Getting members in that group actively involved in their health improves outcomes and lowers costs.

Segmenting members into distinct groups is an absolutely crucial first step in creating a member engagement program that will make a difference for patients and for the plan.

2.    Target the Right Activities

The second important question when it comes to member engagement is figuring out what any given segment of members should do to improve their health outcomes. Motivating a group of members who have diabetes to make and keep an appointment for an annual eye exam can close a care gap, but asking a group of members under the age of 45 who have thyroid disease to get a colonoscopy is less useful for the plan and for the members.

To some degree, targeting activities is another part of segmenting members, but careful personalization makes a huge difference. Members are far more likely to pay attention to messages that are directly related to their own health conditions.

3.    Communicate the Best Way

Choosing the best communication channel for any given member is another pillar of a successful member engagement strategy. A member who uses email, social media and text messaging is unlikely to respond to a direct mail campaign. Similarly, members who mail in checks to pay premiums are unlikely to respond to a social media campaign.

Using segments of a list to decide which activities are most important to improving members’ health is fairly straightforward, but within any segment, there will be members who prefer mail, email, texts and social media communications.

Aside from the complexity of choosing the right channel for the right member, there’s also often an issue of not having a direct line of communication at all. In an article about improving member engagement in HealthPayerIntelligence, the author describes how Blue Cross Blue Shield of Michigan faced a challenge: “Since most of its members were in the group health insurance market as part of an employer-sponsored health plan, the payer did not always have a direct channel of communication with the member.” The plan worked closely with the employers, deployed its app and focused on creating multichannel engagement tools to reach members.

Provide Motivation, Ability and Triggers for Change

Understanding who needs to take action, what action they should take and how to tell them to take the action might seem like a complete engagement strategy. However, other very important steps are all too often overlooked. To take the desired action, members must change their behavior, and that represents an additional challenge. They must be motivated to make that change, have the ability to do so, and have a trigger to help them know when to do it. Communication from a health plan is the trigger, but other factors can limit members’ motivation and ability to change their behavior.

Consider an initiative designed to help members who have chronic low back pain try other treatment approaches before being evaluated for surgery. The member is in pain. They see their primary care doctor, who tells them to rest and heal. The member must continue working, and the pain gets worse. They go to the emergency department because the pain is so bad and get referred to a surgeon who suggests a procedure.

What if the member received targeted communications about physical therapy after their primary care visit, along with information about their plan’s coverage for physical therapy? What if they continued to receive communications about effective alternatives to surgery for treating chronic low back pain over the next year?

The member is part of a segment of people with chronic low back pain. Advanced analytics can identify them as someone who needs intervention after the visit with the primary care provider. Communicating in a way that the member prefers increases the likelihood of them receiving the information.

The motivation is the need for the pain to stop. The ability to take the desired action varies, but providing information regarding coverage can help, and the trigger is the series of communications about chronic low back pain.

When members are engaged, health plans save money and members continue to choose them year after year. The benefits of becoming active participants in their own health is clear for members, as well. Most people want to enjoy better health outcomes and to feel empowered to make decisions and effect meaningful, positive change in their lives. A successful member engagement program can deliver results for both plans and members.

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