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Today’s empowered healthcare consumer is driving a seismic shift in how health plans design the overall experience of their members. Member expectations have changed, and the bar has been raised in several key areas as consumers begin to compare their healthcare experience to other services that they interact with daily:

  1. They expect access to their own health information, just as they own the data they share on social platforms like Facebook.
  2. They want personalization that takes their preferences into consideration, just as their Netflix recommendations are determined.
  3. They want the convenience of requesting a service on demand from their cell phone, just as they summon an Uber from the airport.
  4. They want price transparency and competitive pricing, just as they have when they comparison shop using Amazon.
  5. They want the flexibility of choosing from a variety of options, just as they can have their online purchases delivered to their home, their office or to their local Whole Foods.

There is no putting the genie back in the bottle and these consumer-driven concepts are permeating how health plans interact with their members to acquire, retain and delight them. The interwoven and complex continuum of closing care gaps, improving clinical adherence, increasing member satisfaction, promoting engagement, maintaining Stars ratings and addressing HEDIS measures can benefit from three foundational elements of member experience borrowed from consumer-focused industries.

Member Profiling

None of the approaches pervading the industries listed above would work if those companies didn’t have a deep and continuously evolving understanding of who their customers are, what motivates them, how they behave and how satisfied they are with their service offering. These insights allow them to tailor messaging across all touchpoints to elicit a desired action. For today’s health plan, this translates to actions that directly influence member outcomes:

Taking medication

Making an appointment for an Annual Wellness Visit

Starting an exercise program to reduce their BMI

Member profiles should factor in both demographic details (geography, age, family composition, education and interests) as well as psychographic data, in this case specific to healthcare, including their attitudes, values and motivation. More and more, health plans are also using social determinants of health like access to care, food insecurity and physical environment to augment profiles. These member profiles provide the framework for plans to tailor communications.  

Personalized Communication

Consumers expect to receive communications that are relevant, timely, actionable and take their preferences into consideration.

Health plans need to collect and apply data on:

  • Channel preferences: phone, direct mail, mobile/SMS, email
  • Message content that incites action, informed significantly by psychographic profiling
  • Frequency of messaging

Off-the-mark product recommendations, spammy marketing emails and incessant robocalls are all big consumer turnoffs. Health plans can fall prey to similar negative sentiment and decreased engagement if they fail to consider the unique needs, goals, and desires of their member segments.

Read our white paper "Finding People in the Gaps" for more on tailoring communications to close care gaps

Lifestyle Alignment

The theme of individualism continues when considering lifestyle and behavior patterns in healthcare. Health plans should understand the propensity of their members to perform at-home tests and screening, their likelihood to visit their PCP for vaccinations, and how often they rely on their pharmacist to provide consultation or point-of-care services.

That knowledge empowers them to expand and communicate offerings that appeal to their members such as retail-administered immunizations, telehealth services, at-home routine screenings and wearables.

As one example of offering convenience to members, health plans that work with BioIQ can leverage Walmart’s retail footprint of nearly 4,800 locations in the US. to administer screenings and immunizations.

“We’ve only started scratching the surface of SDOH’s impact on healthcare. While consumerism is still a relatively new concept in our industry, the more we can meet patients where they are through offerings such as retail and home screenings, the more we’ll be able to drive positive, substantial change.” – Carrie Cowdin, Senior Vice President of Analytics, BioIQ

Pulling It All Together

Armed with profiling data, a segmented communication plan, and services that address lifestyle needs, health plans can begin building out a system that humanizes analytics to align their outreach models to different member cohorts while addressing their care gap priorities.

  • A tech-savvy member who is already highly-engaged in his health and at low-risk may respond well to a digital communications approach, optimized for his preference to receive email.
  • A member who has housing insecurity, multiple chronic conditions and lives in a rural area needs a high-touch communications plan, more options for access to care, and disease management education to ensure her health needs are being met.

While these are over-simplified examples at both ends of the spectrum, incorporating consumer concepts is vital to the success of a health plan’s member experience strategy.

To learn more about how consumer profiles can be used by health plans, watch our Webinar Replay: Clinical Adherence Starts with Member Experience

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