With the political and social landscape constantly changing, building a profitable business model isn't easy. The variables and complexities involved can easily become overwhelming for leadership in their efforts to reasonably forecast business growth. One workable solution for health plans is to focus on the basic fundamentals of business growth.
Health Plans can't control or predict what rulings, policies, regulations, or changes will happen in the future, yet they can control their organizational capabilities when it comes to understanding their members. There are personalized ways health plans can improve member engagement and profits.
To begin, health plans face challengers other businesses do not.
- healthy members are choosing the cheapest plans
- members are sicker than health plans are aware of
- uninformed members are choosing unnecessary and expensive treatment options
- satisfaction ratings are low due to lack of communication and understanding of benefits
- lack of risk stratification data leads to unpredictable expenses
- lack of risk stratification data leads to inflated risk adjustment claims (danger of audits)
- policies are changing for risk adjustment reimbursements
- members don't understand their health plan needs or options for treatment
- health plans don't have viable engagement strategies to properly assess members' health
Initial Connections are Not Enough
These challenges boil down to the same issue: health plans need better information about their members in order to properly assess risk factors, and members need better education about plan benefits and which plans might be right for them. In fact, making better connections with members may allow health plans to conduct much-needed health risk assessments (HRAs). To do this, health plans must better engage their members from the beginning.
The initial connection with members is vital for creating future engagement opportunities. While health plans can make inroads in patient education during the initial connection, future engagements will produce greater opportunities for educating them and conducting health risk assessments (HRAs).
Setting up future engagements where HRAs can be conducted and members can be educated about their plans and options is a major challenge for many health plans. Their lack of engagement strategies after the initial connection depends too much on the initiative of members, thus resulting in engagement gaps; basically, the next time they'll hear from members is after a claim is submitted.
Ongoing Engagement Strategies with Members
What health plans need are ongoing engagement strategies that don't hinder their streamlined workflows. After initial and post-discharge connections take place, health plans need to have a strategy to connect with patients on a personal level through a healthcare professional.
There's no better way to connect with members on a personal level than offering them in-home visits by a doctor. During these in-home visits, members can be educated on a deeper level about what health plan is best for their needs, and comprehensive HRAs will give healthcare professionals the data needed to properly consult members on their health conditions and needs.
Another ongoing engagement strategy for health plans to engage with members is to offer them visits to a nearby retail clinic. This is an excellent way for health plans to keep members out of the emergency room or PCP's office when all they really needed was to stop by a nearby retail clinic for medical treatment. While members are there, HRAs, lab and ancillary services, as well as medication and overall care management, can be accomplished.
A third membership engagement strategy is for health plans to offer members telehealth visits. If an in-home visit or retail clinic visit isn't possible, this option gives health plans another personalized way to conduct HRAs and educate their members on the right health plan for them and the detailed benefits they offer.
Member Engagement Liaison for Health Plans
By adopting these personalized member engagement strategies, health plans are essentially working with healthcare professionals who serve as member liaisons. Instead of having to rely on data from providers and claims for risk stratification and risk adjustment reimbursements, health plans will have all the data they need to predict profitability, better serve their members, and raise satisfaction ratings.
The best part is health plans can accomplish all of this without hindering their workflows. Starting from the initial connection with members, MedXM enhances and improves organizational control and capability through member engagement.
While there are many variables that can't be predicted or controlled in the healthcare industry, improving member engagement isn't one of them. If interested in learning more please contact MedXM today.