Customer Experience and Design

Member-centric Care: Have we missed a core team member?

Recently rolled off a large payer, I am sitting back and reflecting on what is facing the healthcare industry today and what has happened over the past 15+ years (Looking at the forest rather than the trees).

1) Are we, all business and information technology professionals, clinicians, and non-clinicians, working on the correct priorities for member-centric care that are facing our core team (i.e., payers, providers, facilities, third-party vendor, regulatory agencies, and members)?

2) Have we over turned every rock (e.g., process, operation, and IT enablement) to allow for member-centric care?

I do not know the billions of dollars that our team (i.e., the core team mentioned above) has put into play to transition the member to being the ball that every team member knows when, where, what, and how to control at their point in time when the ball is in their hands. Do you know the total costs for this team? 2010? 2011? 2012 projections?

Added to this, all the other team members have to be alerted, notified, IMed and prepared for execution if possibly the ball comes their way. Sometimes the team has to pause to be sure the other team member is ready to receive (thinking pre-service and peer-to-peer reviews, transition from in-patient to home care, case management of critical conditions) and receive verification that the team member has received the ball. Don’t forget tracking and replay.

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Here is my assumption and am looking for your thoughts: I think we have missed a team player and not over turned a rock (i.e., addressing numbers 1 and 2 above).

Do you know? Below are several hints. The answer will be on my next blog, later this afternoon.

HINT: We missed the same team player with consumer-driven healthcare (thinking HSA and HRA roll-out).

HINT: This team member is paid monthly by the Payer to provide services to members if called upon by the member.

HINT: The team member is state licensed

HINT: The team member is the first point of contact to bring a member into the network.

FYI – During my 15+ years of consulting and 10 years industry work, with a majority of both being Healthcare, I was at one time this missing team member. I will have insights or perspective that may assist us in over-turning this rock/process/system.

I’m looking forward to your thoughts and answers.

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