The New Role of Healthcare Insurers – Advocates in Patient Engagement

We asked Dogu Celebi, MD, MPH, Chief Medical Officer of Decision Point Healthcare, to explain how engagement analytics is changing the ability of insurers to affect patient outcomes and improve their bottom lines.

  • How can an insurer become an advocate in patient engagement and healthcare as it relates to wellness and care?There are several converging factors allowing insurers to serve as patient advocates, starting with the changing nature of healthcare – from finance to care delivery – where the industry is moving toward a value-based system.

    Value-based payments
    – At the heart of such a system are clinical and non-clinical outcome measures that drive payment to providers and value to the insured. When we talk “outcome measures,” we mean measures of evidence-based medicine and a patient’s ability to adhere to health and wellness recommendations and plans, which together form the first layer of a value-based payment system.

    Persistent focus on Evidence-Based Medicine
    – Today’s healthcare system emphasizes making sure clinicians and physicians have enough evidence to prescribe appropriate care. Over the past two decades, the application of such knowledge to care has made significant in-roads.

    Patient engagement – A great deal of work is being done to influence patient behavior, including getting them to embrace a prescribed care plan or course of treatment. Getting patients to be proactive advocates of their own health and wellness ensures better overall health outcomes.

    The most at-risk patients are those who were traditionally under- or uninsured or lacked access to care. They often have little experience navigating the financial, administrative, and delivery system of care. Decision Point helps health plans identify and communicate with these individuals so that they can achieve positive health outcomes.

  • What are the benefits of improved patient engagement to healthcare insurers?The ultimate benefits to insurers are three-fold: improved clinical outcomes, greater patient satisfaction, and higher rates of retention because of greater loyalty and an affinity to stay with a particular healthcare provider AND insurer.

    At the same time, insurers can also see a positive bottom line impact because of more efficient delivery of services, cost and service utilization improvements, and the elimination of redundancies – avoiding unnecessary tests and evaluations often requested when physicians establish new patient relationships. Combined, this greatly affects marketplace reputation and overall satisfaction across the healthcare continuum from patient to physician to insurer, but in the end, the ultimate beneficiary is the patient.

  • Just how accurate is big data and engagement analytics to predicting and changing future behavior?
    The combination of big data and engagement analytics deliver practical information that helps plans better understand the level of patient engagement and what drives engagement. Our approach provides a high-powered lens into the factors that enable individuals to engage in the healthcare system and management of their care, as well as the barriers to preventing or limiting individuals’ participation in managing their care. Our models help identity the WHY and the WHAT to patient motivations, limitations, and opportunities. As a result, we can predict which who will comply with the care plan and who will not.Compliant populations – Predictive models help determine who can navigate the healthcare delivery systems and effectively manage their own healthcare by doing things like scheduling follow-up appointments, taking the proper medications as prescribed, and even arranging screenings and regular tests.

    Noncompliant populations – Quantitative analysis also looks at populations and zeroes in on the most important factors to predict which patients will not comply with recommended screenings or adhere to their prescribed medications. This can potentially be due to a variety of factors, such as financial or geographical constraints, such as distance from a pharmacy or their healthcare provider, it can be personal factors like health literacy or relationship with their doctor, or it can be clinical factors like the severity of their disease.

    Remedial communications – Once the insurer has identified at-risk individuals, they formulate a patient-engagement plan designed to help change their behavior. Communication of these plans are delivered via the optimal communication channel (such as phone calls, emails, home visits, etc.) based on an understanding of a patient’s channel preference, and tailoring the communication to a patient’s barrier(s) to engagement.

    By tailoring communication and outreach to an individual’s unique scenario, these scripts are more effective in creating a positive outcome for all parties.

  • Are there certain populations that are more open to actions that affect behavior?The individuals who are most amenable to behavioral change are those who historically have not been part of the healthcare system, or people who are part of the system but not engaged due to specific barriers like affordability, lack of transportation, or an inability to support themselves.

    Individuals with just one or two barriers typically are the most adaptable to adjustments. It is straightforward to create engagement plans for them that address specific points of resistance, such as arranging a transportation for a patient or providing home care.

  • Explain through examples where proactive engagement by healthcare insurers resulted in positive ROI.There are several good examples of how engagement analytics have helped insurers improve the quality and outcome of patient care.

    Screening compliance – Using engagement analytics, insurers have been able to improve member compliance with mammography and colorectal screenings, diabetic testing, as well as other screening processes. By helping reach out with targeted messages to at-risk members, insurers have effected upwards of 5-12 percent improvements in screening rates over the course of a year. These improvements are compounded and sustainable year over year.

    This ability to tailor and communicate specific messages to each at-risk individual is what ultimately makes these programs successful. Communicating the right message to the right people can make a big difference in their health outcomes as well as measurable financial difference for the insurer.

    Member retention – Medicare plans, in particular, want to reduce churn and improve member satisfaction. Engagement analytics help these plans identify the individuals most likely to change insurers, and then develop appropriate and targeted messages. When compared to a control group, these efforts have yielded a 20 to 30 percent differences in churn rates.

    Ultimately, deploying engagement analytics can to deliver significant and sustained improvements across almost all metrics – marketing, sales, and customer service – year over year.

Attend the Analytic Approaches to Maximize Population Health Initiatives session presented by Dogu Celebi, MD, MPH, Chief Medical Officer of Decision Point Healthcare Solutions, Oct. 21 at the Healthcare Member Engagement Conference in Las Vegas.

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