As noted by Bridget Van Kralingen, a senior vice president at IBM, “The last best experience that anyone has anywhere becomes the minimum expectation for the experience they want everywhere.” Our team often calls this “the Amazon effect,” because today’s consumers expect the easy, intuitive experience they have shopping on Amazon everywhere they go on the internet — including with their health insurance provider. And you know what? They’re not wrong to do so.

Your health insurance organization has the capability to implement a consumer-centric, omni-channel strategy that anticipates members’ needs.

Imagine becoming a true advocate for your members’ health and wallet, especially for members who struggle with both. 

“Sure, Marybeth,” you may be saying to yourself as you roll your eyes. “And I want a pony too.” Well, it’s true! (Maybe not the part about the pony.) Your health insurance organization absolutely can lay the foundations for better, more positive and more meaningful interactions with your members. And it all rests on your ability to predict their needs and address them through proactive messaging, especially on their mobile devices.

I promise, this is not a pie-in-the-sky dream. This is achievable right now using data you’re already collecting from your members. Our industry experts know what it takes to get this done for our healthcare clients. And we’re the right choice to help your organization implement it within your enterprise. Let’s explore the details, or feel free to contact us for more information.

Your health insurance organization has a trust and understanding problem

By and large, healthcare consumers don’t trust health insurance companies. We know this, and the data backs us up.

But where does this lack of trust come from? In part, it comes from the fact that, despite health insurance companies wanting to serve as stewards of their members’ healthcare, many of them simply react to it instead of acting. Pay a claim, process a prior authorization, etc. — the interactions depend on the member doing something and the payer organization then reacting to it. The onus is all on the member to navigate the system alone until there’s something to be done.

This is not what members want. As KFF’s studies show, consumers want to better understand their options and coverages. Those who have problems with their insurance providers tend to have problems understanding their options under their plans.

There’s no way busy people who aren’t health insurance experts should have to figure this all out for themselves. As they used to say on the TV infomercials, “There’s gotta be a better way!” And, as it happens, there is.

Proactive nudges and interactions can help you build trust and increase understanding

Being an advocate means being relevant in their time of need and of course, doing your best to anticipate their needs.

• Find in-network specialists if diagnosed with a certain condition; use the phone’s geolocation to inform the distance to a provider
• Compare specialists based on cost/distance/facility
• Get a cost estimate for appointment based on coverage and plan spend to date and a reminder the day of the appointment
• See cost-saving alternative medications from the plan formulary based on current prescriptions
• Show prescription phone notifications connected to the provider’s care plan
• Connect with the member’s wearable(s) health trackers to add funds to an HSA or FSA
• Connect the member to available support resources and affiliated/third-party options

You may be telling yourself, “We have that in the portal.” or “We email that vendor solution to our members.” Yes, the abyss of email and portals is all irrelevant noise when it’s not shared in the moment that matters!

None of these should wait for the member to start communication with your organization. Your team should be leading the charge with proactive nudges — push notifications, texts or emails, depending on the member’s chosen communication preferences — with robust campaigns geared toward helping guide the member toward relevant resources and plan benefits they may not know they can access.

Where does the data come from?

All these communications and strategies rely on a massive amount of member data. But this is all data you’re almost certainly collecting now through HIPAA-compliant means through everyday member interactions, such as:

• Behavioral data
• Data from provider organizations (one-off claims; pre-authorizations for a series of care that indicates the management of a chronic condition; etc.)
• Passive and ambient smartphone data
• Systems integrations, including connected health apps
• User-provided data

Active nudges and messaging strategies simply depend on you putting the power of this data to work to benefit the member and their unique healthcare needs. And this is a goal today’s healthcare consumers want to achieve from their technology and online interactions — everything from wearables and nutrition trackers to condition-specific apps and augmented reality. Integrating this data in a holistic way and translating that into discrete advice for members can be a value-added service your team provides.

Take the next step with our industry experts

There are things you can do right now to make your members’ experiences better and more meaningful and have better long-term effects on their health and wellness. Through proactive interactions and nudges to members’ mobile devices, making use of data they already provide in HIPAA-compliant ways, you can set yourselves apart from your competitors and stand out in the minds of both members and potential future members.

We offer the strategic and technical experience you need to achieve real-world, measurable results that will have positive impacts for your business. And we’re ready to put that experience to work for your team. Contact us today to discover why the 10 largest U.S. health insurers have counted on us and to learn more or to schedule a consultation with our team.

Are you considering caregiver experiences in your digital strategy? The complexity of today’s healthcare ecosystem can be incredibly daunting for those who are unwell, older, or navigating complex care decisions. Caregivers can play a crucial role as advocates and supporters but are often approached by healthcare organizations as a siloed aspect of the care experience.

Caregiver Experiences Matter to Consumers and Your Business

In a recent blog series, I explored why healthcare organizations (HCOs) can and should support caregivers who are supporting the patients and members your organization serves. Supporting caregivers makes good business sense for your HCO. Remember, supported caregivers:

• Lead to more satisfied patients/members
• Demonstrate your HCO’s value proposition, which leads to more conversions
• Help your patients/members adhere to their care plans, which leads to healthier patients/members overall

1. Understand the beginning of the caregiver journey

The surge in caregivers isn’t going away anytime soon. But by having a solid strategy in place, your HCO can differentiate itself from the competition and earn loyalty from caregivers and patients and members alike.

Read More: The Caregivers’ Journey, Part 1: Guidance

2. Understand the stress family caregivers are under

The role of a caregiver is a demanding and difficult one. But it’s a necessary one. And by providing the support these indispensable individuals need, you not only make the experience more reasonable for the caregiver, but you also can ease the minds of your patients and members, as well as build loyalty from both.

Read More: The Caregivers’ Journey, Part 2: Stress and Support

3. Be mindful of caregivers’ logistical challenges

Nearly every aspect of family caregiving is a challenge, but the challenges aren’t insurmountable. When your HCO provides the resources caregivers need, you ease their burdens — as well as those of your patients/members — and build loyalty that lasts.

Read More: The Caregivers’ Journey, Part 3: Logistics

4. Understand the beginning of the caregiver journey

Caregiving is a spectrum. Your HCO is likely to interact with many people on varying points of that spectrum. Understanding what that looks like for your patients or members, as well as the loved ones and allied professionals involved in their care, can help you provide the best possible experience for everyone.

Read More: The Caregivers’ Journey, Part 4: Roles and Permissions

5. Enable open, quick communication among HCOs, patients/members and caregivers

The need for caregivers is on the rise. Having the tools and procedures in place to ease the experience for them only makes the process better for your patients and members and everyone involved in their care.

Read More: The Caregivers’ Journey, Part 5: Open Lines of Communication

Resilient, Transformative Care Experiences

Health plans have an opportunity to build trust and maintain and grow market share by providing breakthrough caregiver experiences that help support the member wellness imperative while lowering costs. With advancements in technology, the ability to digitize the caregiving experience is here. Digital experiences can provide important insight into a loved one’s health and activities and enable intuitive tools to uphold medication adherence, coordinate appointments and transportation, facilitate regular updates to physicians, and more.

We can work with you to provide a high-quality caregiver experience through our caregiver enablement approach.

To learn more, or to schedule an introductory workshop, contact us. Discover why we’ve been trusted by the 10 largest health insurers and the 10 largest health systems to shatter boundaries, obsess over outcomes, and forge the future of healthcare experiences.

In this series, we’ve been discussing how your healthcare organization (HCO) can support the caregivers who are caring for your patients and members and why it makes good business sense for you to do so. When the caregivers who are supporting your patients/members feel respected, seen and understood, it has many benefits for your organization, such as: 

• More satisfied patients/members 
• More conversions by showing your HCO’s value proposition 
• Healthier patients/members by helping your patients/members adhere to their care plans 

Let’s review what the series has and will cover:

• Part 1 discussed the guided journey you can offer for caregivers
• Part 2 exploreed how you can connect caregivers to support systems and services 
• Part 3 considered the logistics of caregiving 
• Part 4 identified caregiver types and the various permissions needed for each 
• This article, Part 5 discusses the importance of open and quick communication among HCOs, patients/members and caregivers 

Easy, complete communication is critical in caregiving situations 

It comes with the territory that if your patient/member has a family caregiver, that patient/member probably isn’t going to be in the best of health. Otherwise, they probably wouldn’t need someone in the caregiver role. But it’s easy to forget about that until the patient/member has a sudden need for medical care, perhaps at an urgent-care clinic or emergency room. 

It could be because of some new injury or rapidly developing condition. Or it could be related to an ongoing concern. Either way, the patient/member needs care right now. And it may not be possible for the caregiver to ensure that their loved one goes to their usual facility or hospital. Maybe they weren’t at home when the situation developed, or maybe an ambulance has to take the patient/member to the closest available facility for fast — even lifesaving — care. 

It’s critical for everyone involved in care decisions, from provider and payer organizations to caregivers, to communicate quickly and effectively about what the patient/member needs in these situations. And your HCO can help. For starters, and most importantly… 

Make it possible to quickly access patient/member data 

Speaking from my own experience as a caregiver for my father — if something comes up and my dad needs care right away, I hope I’ll be able to get him to a facility within the provider organization system that normally cares for him. But urgent and emergency situations don’t often happen in ideal circumstances. It’s entirely possible that I’ll have to someday take him to a care facility outside his normal system. If that happens, it’s not good for anyone involved if I have to figure out how to get my dad’s medical records shared with this new organization: 

• My dad, who’s already likely to be scared or irritated, will only have his feelings worsened if I’m distracted 
• I’ll be upset by the situation and only more frustrated if I have to be distracted by this new wrinkle of hard-to-access information 
• The provider will be working with one hand metaphorically tied behind their back if they don’t have the full information about their new patient

This problem only gets compounded if the caregiver has to take the patient/member to a care facility that’s out of the patient/member’s health insurance network. The payer organization will likely require transfer back to an in-network facility as soon as possible. So the caregiver will have to do the information-transfer rigamarole at least twice. 

 Wherever your HCO can, make it as easy and straightforward as possible for caregivers to share needed information from your EHR to another provider in times of need. This helps ensure quality of care and continuity of care in every situation. And it likely will help make life easier for care teams when patients come back into their systems after these emergencies. Work with your IT team to figure out where and how your HCO can allow quick records transfers to another system. What needs to be done on your end, and how can you make this process easier for patients/members and caregivers?  

Teach caregivers what to say and do before a crisis 

The healthcare system is complex and challenging for laypeople on their best days. And a caregiver who’s facing an emergency with their loved one is not going to be having their best day. But even if there’s no “easy button” for a technological solution caregivers can access in an emergency, you can still help prepare them ahead of time.  

Find ways to share the information a caregiver is likely going to need to share with another provider or HCO. Whether that happens during an appointment with a provider, in a support-group setting or in prepared materials — or even all three — take opportunities to coach caregivers on what they’ll need to do and what materials they’ll need to provide in situations where they need to take the patient/member to another provider or facility. 

Help caregivers understand what a triage nurse is likely going to ask about their loved ones. Make a list of the various records another organization will need to understand the patient/member’s condition, medication allergies, etc. And show them how to find and share this information as quickly as possible. 

Of course, the ideal scenario involves the caregiver being able to do all this electronically. But if that’s not possible, encourage the caregiver to have copies, whether saved as PDFs or even printed out, and have them readily available to bring to care facilities in an emergency. 

Facilitate instant communication between caregivers, family members and care teams 

The expression “It takes a village” may have been coined in reference to children, but it definitely comes into play for caregivers and their adult loved ones as well. Whether caregiving duties are shared among siblings for an older adult or the primary caregiver hires help from a professional in-home caregiver, everyone needs to be on the same page about the patient/member and their care. 

 Allowing a space for those involved in caregiving for a patient/member to coordinate their efforts can help ease everyone’s mind. Not only does this type of solution avoid the communication of patient information in a potentially insecure text or email app, but it also could allow caregivers to easily refer to information about vital signs, prescriptions, etc. An added bonus: You could even allow a swift sharing of data to the patient/member’s primary care provider, specialist, etc., as needed. 

Show caregivers that you care about them too 

The need for caregivers is on the rise. Having the tools and procedures in place to ease the experience for them only makes the process better for your patients/members and everyone involved in their care. Our team is here to help you maximize the caregiver experience with our caregiver enablement approach. 

 To schedule an introductory workshop or learn more, contact us. We’d love to talk more with you about your challenges related to caregivers and their needs. 

In this series, we’re discussing how your healthcare organization (HCO) can understand and address the needs of caregivers who are caring for your patients and members, as well as why it makes sense from a business perspective for you to do so. When caregivers of patients/members within your organization feel seen and supported, it leads to:

• More satisfied patients/members
• More conversions by showing your HCO’s value proposition
• Healthier patients/members by helping your patients/members adhere to their care plans

Let’s review what the series has and will cover:

• Part 1 discussed the guided journey you can offer for caregivers
• Part 2 explored how you can connect caregivers to support systems and services 
• Part 3 considered the logistics of caregiving 
• This article, Part 4 identifies caregiver types and the various permissions needed for each 
• Part 5 discusses the importance of open and quick communication among HCOs, patients/members and caregivers 

Identity crisis: Challenges inherent in the ‘caregiver’ term

We can all agree that caregiving is an essential function in modern society. But there often are difficulties in people’s understanding of who actually is a caregiver.

For example, some family members or loved ones don’t like to think of themselves as a caregiver. They think that’s solely the role of a professional — a nurse, a certified nursing assistant (CNA), a home health aide (HHA) or another medical worker — who is in the home, providing medications, taking vital signs, providing meal/bath assistance, taking the patient/member to appointments, etc. These loved ones think “caregiver” is a medical term, and they’re helping the patient/member out of love or duty, so the term shouldn’t apply to them.

I can relate to those feelings. I initially felt uncomfortable thinking of myself as a caregiver when I stepped into the role for my aging father. I don’t live close by him, and I wasn’t the one actually providing his care. What right did I have to call myself a caregiver?

But I had to come to terms with the idea that there’s no one-size-fits-all solution to caregiving and no neat, tidy way of subdividing its different forms. All of us in this community are focused on helping others who are sick or aging. And all of us need support from the HCOs who provide care for their patients/members.

However, those varying, sometimes-nebulous definitions of “caregiving” mean your HCO needs to offer different access rights and permissions to the digital experiences of your patients/members based on which type of caregiver persona needs to access information at a given time. (And bonus points to you if your organization has included both types of caregivers in your persona and journey mapping efforts!)

Persona 1: The professional caregiver

This is the skilled worker whom the family caregiver (more on them below) hires to care for the patient/member. They’re in the home with the patient/member on a regular basis, whether daily, weekly or some other cadence.

This person needs to be able to access the patient/member’s digital tools for several vital caregiving activities, including:

• Logging prescription adherence
• Helping and logging exercises and activities (walking, chair exercises, etc.)
• Monitoring vital signs, such as heart rate, blood pressure, oxygen saturation, etc., as well as trends over time
• Observing and monitoring mental health state well-being

These are critical data points for everyone involved in the care of a patient/member. Not only does the care team likely need these regular updates to adjust care plans as needed, but the family caregiver needs them to be informed about their loved one’s status and make the best decisions possible about their care.

However, simply granting the same levels of permissions as a family caregiver/healthcare proxy isn’t reasonable for a professional caregiver. There’s no reason for this individual to have access to insurance information, payment details or even support systems. These details are unnecessary at best and can expose your patient/member or family caregiver to the risk of identity theft or worse.

Persona 2: The family caregiver

The family caregiver serves as the patient/member’s primary support person. They may even be making all medical decisions for the patient/member if a healthcare proxy is in place.

If a professional caregiver is involved in the patient/member’s care, the family caregiver likely doesn’t need access to the day-to-day activities of logging vital signs, prescription adherence and so on. They’re probably not in the patient/member’s home managing these activities. And too many updates could serve as a source of stress due to information overload (especially given that caregivers are under considerable stress already).

However, family caregivers do need access to essential information relating to their loved ones’ ongoing care, including:

• Proper management of the aforementioned healthcare proxy
• Health insurance information, including coverages, deductibles, etc.
• Access to the patient/member’s electronic health record (EHR)
• Location tracker for the patient/member
• Dynamically generated information on where to find more or related care based on the location of the patient/member, not necessarily the family caregiver
• Summary of vital signs and/or trends over time
• Calendar of family coverage (e.g., who’s taking Dad to this appointment on Tuesday?)
• Access to your HCO’s own community of caregivers and/or available support options

The right access to the right kind of caregiver

Caregiving is a spectrum. Your HCO is likely to interact with many people on varying points of that spectrum. Understanding what that looks like for your patients or members, as well as the loved ones and allied professionals involved in their care, can help you provide the best possible experience for everyone. We can help you strategize about maximizing the caregiver experience through our caregiver enablement approach. To schedule an introductory workshop or learn more, contact us.

And don’t miss Part 5 of this series. We’ll discuss why it’s vital for HCOs, patients/members and caregivers to have easy and open lines of communication, particularly when the patient/member needs a new facility or type of care. See you then!

In this series, we’re talking about how your healthcare organization (HCO) can support caregivers who are caring for your patients and members and why it makes good business sense to do so. Remember, giving caregivers the resources and support they need leads to:

• More satisfied patients/members
• More conversions by showing your HCO’s value proposition
• Healthier patients/members by helping your patients/members adhere to their care plans

Let’s review what the series has and will cover:

• Part 1 discussed the guided journey you can offer for caregivers
• Part 2 explored how you can connect caregivers to support systems and services 
• This article, Part 3 considers the logistics of caregiving 
• Part 4 identifies caregiver types and the various permissions needed for each 
• Part 5 discusses the importance of open and quick communication among HCOs, patients/members and caregivers 

Be mindful of caregivers’ logistical challenges

Many healthcare organizations (HCOs) are accustomed to dealing with consumers only within their service areas. But family caregivers often present a new consideration because they may not live with the patient or member. For example, I’m a caregiver for my father, and I don’t live in the same city as he does. This can make it more difficult to:

• Coordinate appointments
• Get him to appointments on time if I can’t take him there myself
• Ensure he’s taking his medications regularly and in line with his providers’ recommendations

Of course, caregivers should talk with their loved ones about these challenges. Together, they can make plans about how to get the patient/member to needed appointments, help find strategies for medication compliance and so on. But patients/members — particularly if they’re older — may not fully understand the instructions they receive from providers. And they may not be able to share that information with family caregivers in an accurate, timely way.

This can make the care experience more difficult and less effective for your patients/members. But there are steps your HCO can take to ease the burden on everyone involved.

Share information and solutions transparently to ease challenges

Transportation issues are a significant hurdle to healthcare for many patients/members, particularly those who are older, have problems with mobility or who otherwise can’t drive themselves to appointments. Your HCO can help address these situations by incorporating transportation solutions into your appointment scheduling and patient portal experiences. Options include:

• Nonemergency medical transportation (NEMT) available through Medicare, Medicaid and some state government programs
• Rideshare services, including Uber Health and Lyft Healthcare
• Local public transit
• Taxi services

For caregivers who may be traveling to bring their loved ones to appointments, make sure listings for care locations on your HCO’s website include links to driving directions (such as on Google Maps). This can save steps and improve the experience for caregivers who may not be as familiar with your service area and locations.

Within your digital experiences, make sure you include a prescription medication adherence tracker that allows caregiver access. This can help caregivers ensure their loved ones are sticking to their care plans. It can also help jumpstart conversations among patients/members, caregivers and providers about:

• Overall health and wellness
• Concerns such as polypharmacy (the inappropriate use of multiple medications)
• The patient/member’s ability to live independently

How you can help caregivers and patients/members by addressing logistics issues

First, providing logistics solutions can provide ease of mind to your patients/members. When they don’t have to worry and stress about how they’re going to get to their medical appointments or whether they’re taking their medications as they’re supposed to, they’re in a better mindset to listen to their providers and align with their care plans. This can lead to better outcomes overall.

Secondly, these solutions can lead to peace of mind for caregivers too. They know they have the resources they need to effectively care for their loved ones. This gives them the time and resources to focus on their loved one’s care, rather than how to get them to appointments or make sure they’ve taken their medication on time.

These solutions make both the caregiver and their loved one feel more confident in the care your HCO makes possible. It builds loyalty to your organization. You’re less likely to lose your patients/members to the competition if it’s easier and more convenient for them to seek care with you as opposed to your competitors.

You can also build on that as a point of differentiation. If you’re leading the way in your service area in terms of easing the care process for patients/members and their caregivers, targeted marketing campaigns and content to that effect in your marketing materials may help draw consumers in.

Caregivers’ logistics issues aren’t easy, but they are solvable

Nearly every aspect of family caregiving is a challenge, but the challenges aren’t insurmountable. When your HCO provides the resources caregivers need, you ease their burdens — as well as those of your patients/members — and build loyalty that lasts. We can work with you to provide a high-quality caregiver experience through our caregiver enablement approach. To learn more, or to schedule an introductory workshop, contact us.

And don’t miss Part 4 of this series. We’ll discuss distinct types of caregivers and what permissions, responsibilities and resources each type needs. See you then!

In this series, we’re talking about why your healthcare organization (HCO) can and should support caregivers who are caring for the patients and members your organization serves. Supporting caregivers makes good business sense for your HCO. Remember, supported caregivers:

• Lead to more satisfied patients/members
• Demonstrate your HCO’s value proposition, which leads to more conversions
• Help your patients/members adhere to their care plans, which leads to healthier patients/members overall

Let’s review what the series has and will cover:

• Part 1 discussed the guided journey you can offer for caregivers
• This article, Part 2 explores how you can connect caregivers to support systems and services 
• Part 3 considers the logistics of caregiving 
• Part 4 identifies caregiver types and the various permissions needed for each 
• Part 5 discusses the importance of open and quick communication among HCOs, patients/members and caregivers 

Understand the stress family caregivers are under

Caregiving is often seen as an expected duty of family members and loved ones. In fact, it’s often one we hear from people about a reason to have children (“Who else is going to take care of you when you get older?”).

As we discussed in Part 1, the caregiving role is often one that’s thrust upon the caregiver unexpectedly. It often happens after a sudden illness or accident — already sources of stress and fear — and often with little or no time to prepare. That’s what happened to me when I suddenly had to step into a caregiver role for my father.

In the short term, we focus on the short-term solutions: taking over appointment scheduling, setting up dialogues with providers and account managers, connecting to resources and support systems, etc. Do all the things!

But, eventually, the stress, sadness and anger will catch up to the caregiver. This is their new normal. The burdens they feel (or may have put off feeling) are real. And they need to do something about it.

It’s natural for a new caregiver to feel angry, sad, and confused about their new situation. They’re learning how to define and navigate this new relationship, which can feel quite different from the one they’re used to. And they may feel guilty about having these feelings. That’s a lot for anyone to have to deal with.

The dual duty of your HCO

It’s common for HCOs supporting caregivers to perform two tasks simultaneously. Not only do you have to offer and surface the support services they’ll need throughout their journeys, but you often must convince them to take advantage of these services in the first place.

Think of the conflict your patients’ caregivers are feeling. They may think it’s weak or ungrateful to feel angry, stressed, resentful, or negative about the caregiving role. In their minds, it’s their job to help take care of their beloved spouse, parent, or other loved one. They likely feel obligated to do so — after all, their loved one has presumably cared for them in the past and provided the love and support they’ve needed.

But this is not the same sort of situation. It’s simply not the same as the love and care a spouse or parent provides for their spouse or child throughout their life. This is never-ending worry and stress about a medical condition that’s not likely to go away. It’s traumatic for the caregiver.

The caregiver owes it to both themselves and their loved one to get the kind of help you’re providing. That’s why your HCO must convince caregivers to seek out that help.

How you can help caregivers care for themselves

First, the basics: Make sure your HCO offers support solutions for caregivers. Next, ensure your website, patient portal, app, and other digital outreach efforts surface and promote support options for caregivers. If there are options other than those you offer in-house, such as support systems available through the cities and towns in your service region, state/national organizations, and others, make sure to include those.

Connecting caregivers to behavioral health and counseling services through your HCO is also important. If you’re part of an insurer organization, help caregivers for your members find options within their network. If you’re a provider, help caregiver consumers understand what plans your HCO accepts, and be sure to surface your cost transparency information.

Support the caregivers who are supporting your patients and members

The role of a caregiver is a demanding and difficult one. But it’s a necessary one. And by providing the support these indispensable individuals need, you not only make the experience more reasonable for the caregiver, but you also can ease the minds of your patients and members, as well as build loyalty from both. Our caregiver enablement approach can show you how to provide the digital caregiver experience your consumers expect and deserve. Contact us to learn more or to schedule an introductory workshop.

And don’t miss Part 3 of this series. We’ll discuss the logistics of an integrated caregiver experience and how this can help ease caregivers’ minds. See you then!

The facts and figures about caregivers — family members and friends who provide care and support to people with chronic health conditions, disabilities and other problems — are staggering. According to the Centers for Disease Control and Prevention (CDC), as of 2020, more than one in five Americans were caregivers. That worked out to about 53 million people. Out of the people who aren’t yet caregivers, one in six expects to be within the next two years. By 2030, about 73 million Americans will be 65 or older. And many of these people will need help from caregivers to maintain their quality of life.  

But numbers are only part of the story. And they can be a bit abstract if you haven’t lived the caregiver experience, as I’m doing now with my father. Family caregivers are often jolted into this experience. Like when I needed to step in and start helping my dad make some important decisions about his health and well-being. I was overwhelmed in a way statistics can’t explain. 

What I did — and what family caregivers like me do every day — is turn to healthcare organizations (HCOs) like yours. Healthcare providers, health insurers, medical device providers and more are vital resources for both the patient/member and the caregiver alike. But the experience for caregivers has been lacking at best and all too often unnavigable. 

The state of affairs for the caregiver journey means your HCO can step up and lead the way for the patients and caregivers you serve. Supporting caregivers makes sense from the business perspective, because supported caregivers: 

• Lead to more satisfied patients/members 
• Demonstrate your HCO’s value proposition, which leads to more conversions 
• Help your patients/members adhere to their care plans, which leads to healthier patients/members overall 

 In this series, we’ll go over five key areas your team needs to consider for caregivers: 

• This article, Part 1, discusses the guided journey you can offer for caregivers 
• Part 2 explores how you can connect caregivers to support systems and services 
• Part 3 considers the logistics of caregiving 
• Part 4 identifies caregiver types and the various permissions needed for each 
• Part 5 discusses the importance of open and quick communication among HCOs, patients/members and caregivers 

Understand the beginning of the caregiver journey 

For most caregivers and their loved ones, the caregiver journey has a definite start. It doesn’t tend to be something you ease into over a long time. A fall, a sudden illness or injury, a new diagnosis — something happens that makes the caregiver realize their loved one needs more help. 

This is a shocking and scary time for caregiver and patient/member alike. The caregiver likely will need to familiarize themselves with their loved one’s care plan, health plan coverage, finances and other information. The patient/member, meanwhile, will be worried about a loss of autonomy, real or perceived, as well as the fear of this new unknown. 

 This is a chance for your HCO to earn trust and ease the minds of everyone involved. An empathetic presence, geared toward the new and uncertain-of-themselves caregiver, will help you start their journey on the right foot. And you can reassure your patient/member at the same time that you’ll continue to be there for them every step of the way. No one gets left out. No one gets forgotten. And everyone feels both seen and heard during this challenging time of new and uncertain beginnings. 

Make everything as easy as possible for caregivers 

New caregivers have a lot on their minds. On top of processing their loved one’s condition and fears of the unknown, there are often matters of paperwork to deal with. The patient/member has forms to fill out, documentation to provide, appointments to schedule and so on. And some or all of that is now the responsibility of the newfound caregiver. No wonder more than 60% of caregivers report experiencing symptoms of burnout. 

It’s not possible for your HCO to take all the newfound responsibilities off caregivers’ plates. But you can ease the burden a bit. For one thing, don’t make caregivers have to hunt and search for what they need to assume their newfound responsibilities. Pull together a checklist of all the documentation caregivers will need to give you to be in the caregiver role and receive communications that ordinarily would be protected under HIPAA and other patient confidentiality regulations. These may include: 

• Advance directives 
• Consent forms 
• Healthcare proxy and/or power of attorney 
• HIPAA authorization forms 
• Wills and living wills 

Provide a centralized location for caregivers to submit these documents. And for the forms your HCO requires the caregiver to fill out, make sure you have a convenient place for caregivers to access and complete them electronically. Bonus points if caregivers can complete the forms digitally on their mobile devices in addition to desktop computers. And, of course, transition away from any forms that require printing, manual entry with a pen or pencil and scanning to upload back to you. 

To go the extra mile for your patient/member’s caregiver, route them to a dedicated care coordinator, social worker or other professional within your HCO who can help guide them along the way. It can be challenging to deal with scheduling multiple appointments, often in multiple locations. And the challenges are even greater if the family caregiver doesn’t live with their loved one. If your organization has resources to ease that burden for caregivers, you’ll earn loyalty and gratitude from consumers by connecting them to people who can help navigate these complexities. 

Customize your caregivers’ portal experience 

We’re starting to see some HCOs provide basic portal functions for caregivers. However, you should consider these features as essential for caregivers who are managing aspects of the patient/member experience for their loved ones: 

• Easy access to appointment scheduling, provider search/your Find Care experience, etc. 
• Coverage details (for payer organizations) 
• Access to nurses for triage (e.g., does X need care, and if so, where should my loved one go?) 
• Explanation of facility types for care options (e.g., when to go certain places for certain types of care) 
• Integrations with services and resources specific to caregivers, such as senior-care providers (e.g., Care.com) 

By homing in on the resources they’re most likely to need, you can make the process smoother not only for the caregiver but also for the patient/member. 

Serve up content geared toward your caregivers 

People new to the caregiver role within your HCO are going to have a lot of questions. You can help them self-serve (and, simultaneously, reduce some of the burden on your staff members) by curating content that answers most or all the questions that aren’t specific to their loved ones’ care plans or coverages. 

Talk with caregivers and patients/members who have specified family caregivers. Ask them what kinds of content resources they either would benefit from now or would have benefited from at the beginning of the caregiving journey. And get input from provider or benefit teams within your organization. You want to make sure the content you create is valuable for them as well. 

Related: Caregiver Healthcare Content: When the Patient Isn’t Your Audience 

Unlock the power of caregiver enablement 

The surge in caregivers isn’t going away anytime soon. But by having a solid strategy in place, your HCO can differentiate itself from the competition and earn loyalty from caregivers and patients/members alike. Our caregiver enablement strategic position considers opportunities to provide the digital caregiver experience your consumers expect and deserve. Contact us to learn more or to schedule an introductory workshop. 

And don’t miss Part 2 of this series. We’ll be discussing the stress of caregiving and how your HCO can help connect caregivers to the support and resources they need during this challenging time. See you then! 

Digital organizations in health payers and providers strive to enhance value for their patients and members.

And the stakes are high for these consumers. After all, healthcare decisions impact health, wallet, and emotional well-being. That means digital experiences become an important opportunity to positively fill gaps – both before and after care is received.

What does it mean to be truly product-driven in healthcare?

To be product-driven, healthcare leaders must launch and listen. Think of your digital products as a trusted source of consumer feedback to fuel your organization’s strategies, even beyond digital.

This is especially important in service industries where there is no tangible good. Your digital products become one of your most powerful assets.

Healthcare organizations often struggle to adopt a product-driven model.

The failures are easy to spot by looking at both the portfolio (top) and the team level (bottom) of the value creation funnel.

At the PORTFOLIO level, you need to ensure an ongoing collaboration to continuously refine and prioritize the business need/case.

• All parties should understand the intended impact of each business case on the organization.
• Digital leadership should be consulted for the anticipated impact on their digital products.

Healthcare is ripe with many disparate segments, lines of business, systems, and specialties. Often, these distinct areas will prioritize their own work and leave the difficult enterprise prioritization decisions up to shared services like digital.

At the TEAM level, you need to ask yourself an important question: are your teams “outcomes-obsessed.” If not, why? (Hint: often, there’s little incentive for outcomes-obsessed behavior.) Let’s look back to the top.

• Very few digital business cases ask for results, which makes the next challenge rather obvious: teams rarely use results to fuel ideation for the following planning cycle.
• This short-sighted approach perpetuates “launch it and leave it” mentality, resulting in:
  • Low utilization of digital products
  • Less-informed leadership teams across the organization

Your digital teams simply move on to the next priority (and, if you ask them, they may tell you that they feel like a factory).

A product-driven digital healthcare organization can tackle these problems at the top of the funnel.

Digital leadership must take place at the portfolio layer.

Digital product management leaders must have a collaborative relationship with stakeholders across various parts of the healthcare organization.

The business and digital leadership should:

1. Share and Gain Perspective

Peers across the business and partners in shared services (like digital) should be a) reviewing and discussing business hypotheses for new work and b) sharing analytics and other feedback from previous work. This kind of collaboration should inspire digital product management leadership to write their own Agile portfolio epics to aid in the organization’s varied goals of growth, retention, satisfaction, etc. Furthermore, all historical digital epic outcomes need to be shared with the business to help influence their work.

• Ideal Timing: This isn’t something merely done once a year; rather a forum to gain alignment and perspective should be on-going.

2. Create Well-Articulated Business Cases

The business hypotheses and intended outcomes should be made clear in draft Agile portfolio epics. The business and shared services, including digital, should come prepared with their best ideas.

• Ideal timing: Given the complexity in healthcare and insurance and the cyclicality of the annual funding process, this should begin no later than April with all drafts completed by end of May.

3. Refine

After sharing your drafted epics and listening to others, refine your business case with impacted leaders.

• Ideal timing: June and July

4. Prioritize and Fund

Tough decisions around what gets done with limited healthcare dollars is decided by the leadership in the project management office (PMO) and should be communicated across the organization. In healthcare organizations, this timeframe is critical to ensure that what you felt were solid business cases in May are still relevant in September.

• Ideal timing: September

5. Be prepared to pivot!

Given the dynamic nature of healthcare and health insurance, be prepared for a new business case at any time during the year (e.g., legislation, M&A, etc.). Depending upon the urgency, it should be scrutinized for its priority against formerly prioritized and funded work and/or the next planning cycle.

PRO TIP! If you are a digital leader who is constantly making tough prioritization decisions, scrutinize the portfolio or program epic for details. The expected business outcomes should help you make the decision. But if it’s political, share those facts back up to the business partners to make the final decision.

Product-Driven Success In Action

Perficient and GoHealth Urgent Care’s partnership has produced an award-winning and highly-rated mobile app that helps customers easily find an urgent care center, save their spot, and register for their visit.

Consumer experiences often lag in healthcare, yet GoHealth’s focus has consistently been to create the best possible consumer experience. Their commitment to Agile-driven product development, steered by user feedback and app analytics, ensures continuous improvement that prioritizes the highest-value features for their customers.

Move From Project to Product With Expert Guidance

Being a product-driven organization offers numerous advantages over being a project-driven one.

1. Defines and tracks business outcomes.
2. Leads to better business results.
3. Supports continuous improvement through iterative development.

Our VP of IT’s Guide to Transforming Your Business guide is an excellent resource for those seeking an even deeper dive. This guide answers IT leaders’ top questions about cloud strategy, data, DevOps, and product development. It comprehensively examines the latest trends and best practices for driving business outcomes through technology.

Interested in truly becoming outcomes-driven? We’re here to help. Learn more here.

Are you a Healthcare Business Leader stressing over how much you should use AI? Don’t be. I’m certain you have a roadmap with some bodacious goals on them. You want to increase engagement and access to high-quality care and drive down healthcare costs, right? Although AI isn’t a magic wand, we can finally start to think bigger and shorten our roadmaps.

If AI can be simply put, it’s a manner of processing massive amounts of data in real time to drive intelligent decisions. It can learn from interactions to improve performance and efficiency. Perhaps you’ve worked with your IT partners on projects that involve machine learning. Machine learning is a less sophisticated subset of AI that uses proven logic models to perform complex tasks.

Data in Use Cases

Every business leader in healthcare is thinking about how to best use their number one asset beyond their human capital – their data. You have mountains of it that can benefit your patients and members. The adventure is how best to unlock it. It’s daunting and machine learning use cases only got some organizations so far. Trusting your data is another blog-worthy topic. Let’s assume we do this for these use cases.

• You’re a provider organization. Your clinicians want to suggest the most proven care plans to give your patients the best possible outcomes.
  • What if you gave them dashboards to browse by chronic conditions and the various care plans that led to the best outcomes?
  • What if the clinician saw those prompts within the EMR while speaking to the patient and could advise them in real-time more confidently?
• You’re a payer. You want to rise above your current proposition by simply being a payer of claims and adding value throughout the care continuum. You’ve got your own claim data to prove what works and what may not. You’ve got the key to the kingdom on what members could pay overtime in one care plan versus another.
• • What if you ask members permission to proactively suggest providers, care plans, and their costs?
  • What if you use real outcome-based data across your enterprise to suggest the best plans for members upon renewal?
  • What if you refined product plan designs to best meet the needs of your clients, members, and organization?
  • What if you devised product pricing strategies for prospects and current clients backed by outcome-based effectiveness?

Does AI feel Unsettling to you in Healthcare?

My colleague Marlana Voerster goes deeper on how AI should be explained to healthcare consumers to build trust instead of the negative “big brother” sentiments many people have right now.

If you are stuck thinking that AI is too unsettling to institute in healthcare, please consider how a healthcare / AI thought leader, Mendel Erlenwein positions it:

“I don’t believe that AI should do everything, the way I see it, I split the care coordinator into two, separating the care coordinator by the heart, and the brain. I think the human being has a unique value proposition in the heart department; patience, delivery of care, empathy, etc., But we also must recognize the unique value proposition of AI in the brain department and its ability to process massive amounts of data intelligently.”

Do you want a Jumpstart on how AI can Fast-forward your Healthcare Roadmap?

Perficient’s CX AI Jumpstart is a new offering that is helping clients quickly define how AI can make the biggest impact on their business by using a cross-functional approach. Built on Perficient’s accelerated modeling process, CX AI focuses on developing an interactive model that demonstrates how organizations can leverage machine learning, natural language processing, conversational AI, generative AI, and cognitive computing to jump-start AI adoption.

Perficient’s award-winning AI practice specializes in analytics, big data, unstructured content management, enterprise search, digital experience, and business optimization to deliver solutions that help businesses turn their information into strategic assets.

Perficient recently launched a global Generative AI Innovation Group (IG). Their charge is to identify and develop market offerings, internal use cases, and applications, and routinely host events that educate, enable, and engage colleagues about the groundbreaking technology and its implications for transforming enterprise operations. For more information about Perficient’s AI expertise, follow us on Twitter and LinkedIn.

About Perficient

Perficient is the leading global digital consultancy. We imagine, create, engineer, and run digital transformation solutions that help our clients exceed customers’ expectations, outpace competition, and grow their businesses. With unparalleled strategy, creative, and technology capabilities, we bring big thinking and innovative ideas, along with a practical approach to help the world’s largest enterprises and biggest brands succeed. Traded on the Nasdaq Global Select Market, Perficient is a member of the Russell 2000 index and the S&P SmallCap 600 index. For more information, visit www.perficient.com.

Proactive private healthcare providers, insurers, and medtech firms in the UK are thinking about how to ease care experiences for their constituents. Yet this journey becomes all the more complicated as individuals move back and forth between private sector healthcare and the National Health Service (NHS).

These unique economic and social aspects of the UK-based system have huge impacts for healthcare leaders. At the core, though, is a responsibility to drive and support the digital experiences of patients, insured customers, and health consumers.

This starts by making sure consumers are aware of your product or service at the most relevant moment: their time of need.

Let’s explore three ideas that will help you build organisational traction and impact your constituents’ engagement with your brand.

Don’t let your customer or patient journeys gather dust

Chances are that your organisation has invested in a set of journey maps that detail how your constituent moves through your product or service. Given the increased complexities and new entrants in the UK market, it’s more important than ever to consider these top three ideas:

Tip #1: Reflect On Your Existing Personas and Journey Maps

Have you been honest about what’s changed since the last time your organisation completed interviews, personas, and journey maps? If you were to pick up the phone today and speak to your end consumer, would their feedback sound a lot different than it did the last time you gathered this input?

Even if you suspect that a market shift may only impact one key moment in the journey, that singular moment could make or break member satisfaction and other ROI metrics.

Ask yourself: “What has the ROI been on our strategic persona and journey map investments?” Then consider if and how your organisation uses the critical insights from those tools beyond the typical realm of marketing and digital experiences. Is that valuable information sitting in a folder somewhere gathering dust? If so, the next two tips are imperative for you.

Tip #2: Embed Journey Insights in C-suite Strategic Planning

Once that first tip is done and dusted, your organisation understands the voice of your constituent. That’s critical.

Now, it’s time to empower all senior leaders to support a healthy bottom line. Create a shared environment where new services, products, and experiences can be ideated.

You might use the following questions to guide these conversations:

• Are there new entrants to the UK market competing with our organisation and making revenue less certain?
• How does our constituent navigate care today?
• How can we try to make their experience as frictionless as possible to attract and retain them?
• How are we moving beyond the basics of retention and thinking more holistically about complete consumer delight (points of differentiation)?
• Where should we focus to make the biggest impact?

Let the research help guide these conversations.

What’s in it for you?

A digital experience leader of any size organisation can often be seen as someone who is trying to push the constituent experience agenda on their own. You or your marketing leader may have created the personas and journey maps for a major strategic initiative, such as a website overhaul or the launch of a new product.

Ensuring the journey of your constituents is understood by the entire C-suite allows new shared ideas to be unlocked. This unified vision then smooths your path through organizational hurdles.

As you facilitate the conversation with your leadership, consider the following:

• Ensure the mission, vision, values, and direction of the organisation align with patient needs and expectations, helping to create additional value
• Prioritise innovation and organisational evolution based on patient needs and wants
• Create a consumer-centric culture that permeates every level of the organisation, flowing down from the top
• Aid in the selection of vendors and partnerships that will best support the patient experience
• Develop new products and services that solve patient problems and add value
• Ensure the consumer’s voice is loud and clear through product and service ideation and development
• Identify areas of clinical importance to consumers, including trends –virtual visits, mental health, and wellness services, to name a few
• Engage your sales leaders to anticipate and resolve objections, allowing them to better showcase value propositions that truly resonate

Tip #3: Align With Customer Service Leadership (It’ll Make Your Digital Agenda Easier!)

As any digital experience leader will confess, the moment their constituent chooses to make a phone call or engage with customer service via chat, it’s nearly out of their hands. However, you’re both accountable for constituent satisfaction.

Even the best digital journeys don’t mean total call deflection.

The best-branded experiences need to be seen and heard from all channels of engagement.

Benefits of journey maps for customer service teams

Customer service leadership should be very focused with you on digesting all the insights from personas and journeys to:

• Ensure patients, caregivers, and families are met with an on-brand experience when they call for help
• Increase understanding of patient problems, needs, and how to help; this is especially critical when a care team member’s demographic doesn’t match that of their customers
• Enable feelings of connectedness and empathy to the consumer and the brand, providing loyalty-building experiences
• Help your team members understand the impact of both planned and sudden life changes and how to best support patients during events

Journey maps can support an organisation in endless ways. As you jump into your next journey map project, consider how different departments can leverage those maps to better engage audiences and enhance your overall brand experience.

Partner with an Expert

Perficient’s digital healthcare strategists have partnered with the largest healthcare and medtech firms to help leaders align organisational business goals with constituents’ evolving expectations.

We can evaluate your current state, identify gaps, and make recommendations for a best-in-class, scalable digital ecosystem that enables your constituents to self-serve and quickly find what they need. We can then align technology to meet your organisation’s capabilities, reusing existing systems or platforms and pragmatically recommending new technology where it makes sense.

Contact us to learn more and get started today.

In my last post on cost transparency, I mentioned how the provider is paramount over the payer in the eyes of the patient/member. Some payers have made this the focus of their strategic growth plans and are methodically moving to become part of a payer-provider “payvider” model.  This vertical integration is on the rise for payers, most notably for: UnitedHealth Group, CVSHealth, Cigna, Elevance and Humana.

There are some serious up-sides to this model from a bottom-line perspective:  

1. When payers and providers merge, they do so because they predict increased profitability.
2. This merge diversifies revenue.
3. The diversification spreads financial risk.

What’s in it for the patients/members?

The hope of value-based care. This means patients and members benefit from higher quality, better outcomes and increased satisfaction at lower costs. This is not to be inferred through a payvider relationship; however, it’s the lofty goal of many payviders like CVSHealth through their “Health Hubs”. As we’ve all experienced, the current fee-for-service model incentivizes the provider into high-volume, low risk patient engagements. This means high # of office visits/day and increased # of tests because there’s no time to fully assess the health situation of the patient. In a payvider model, the spread of financial risk provides more breathing room for providers to focus on value-based care.

• In sum, patients/members have more meaningful provider engagements = less unnecessary spend in healthcare = increased payer profit (through overall reduction in cost of care) = payvider system spread its risk

The model works

Research has proven that the payvider model is successful with patients but it requires thinking about healthcare consumers in a new light. “Vertically integrated models of patient care and coverage have been shown to outperform other models of care and coverage in patient experience and perception1.”

A shift in advocacy – What I like about this model is that the provider is doing what the patient has always wanted them to do, advocate on their behalf. When you spend the time on prevention and wellness, you can reduce healthcare risk and spend. This result is the ‘wellness company’ that many payers have been striving to become for years.

How should integrated models of healthcare engage their patient/members differently?

Should we call them pat-bers? Mem-tients? It doesn’t nearly have the same ring to it as Payvider and Bennifer.

They want the ultimate in connected, personalized care. The digital experiences should complement the health advocacy from their providers.

1. Give me one “umbrella” digital experience across all of my healthcare experiences – this means one authenticated environment with many connected channels
2. Suggest the best providers for someone like me, given preferences, desired outcomes and total cost (including my health plan coverage)
3. Suggest the right facilities for each care type – tell me when it’s beneficial for me to wait for my PCP versus head to urgent care versus seeking local speciality care or needing to seek care at an academic medical center
4. Help me manage all of my appointments and integrate them into my phone’s calendar and app
5. Suggest the drugs that you’ve seen successful for someone like me; and include me in the care decisions around drugs needed to address my medical issue before a drug is prescribed
6. Tell me exactly how much I’ll spend before I seek care as of a specific date – for both preventive and complex care needs
7. With enhanced focus on wellness, connect my wearable and other devices or apps so that I can integrate data so my providers have a more complete picture of my health. Consider gamification as I seek to earn rewards in my health savings account (e.g. heart rate monitor, sleep apnea machine, fitness and nutrition tracker, etc.)
8. Make it easier for me to get to the functions within the authenticated app and portals. Help me give you all the right permissions to help make it happen
9. Serve personalized content to me that learns and adapts to what I engage with
10. Regarding health advocacy, make it easy for me to share my health data and actions with a person I trust

With these strategies, payviders can provide a best-in-class consumer experience. We are the experts. Call us.

¹ Orzag and Rekhi, “The economic case for vertical integration in health care”, 2020

There’s been a lot to say about the cost transparency legislation that came out a few years back from CMS. The final step in the legislation is due January 2024 and requires that health plans aka “payers” ensure that their members have access to far more robust and accurate cost of care tools. These enhanced tools must show accurate procedure costs for an episode of care (e.g., knee surgery) and apply where the member is within their plan year (amount of deductible or out-of-pocket met).  

Most payers are well on their way to updating their existing tools hidden in their portals and apps to ‘check the box’ on this legislation.  How many of them are seeing it as a moment to capitalize on consumerism and gain greater market share?   

Will health plan members use the updated cost estimator tools?  

Most health plan digital and business leaders are focused on how to get more traction from members on their apps. One national payer recently shared with us that the existing iteration of the estimate the cost of care tool was only responsible for 2% of traffic.  

 It’s important for health plans to step back and recognize that their members are first and foremost, patients. Patients are already inundated with the provider digital experiences that are far timelier and more relevant in their journey. Providers aren’t afraid to ask you for permission to send even sensitive information in the channel of your choosing. What are payers waiting for? Permission? Then go get it!   

Do you remember the last time you sought care? For me, it went something like this: 

• Patient Text message: “Click here to prepare for your upcoming visit.” They’ve easily guided their patients through questions they formerly had to do in-person via paper, making them potentially late to begin an appointment. (E.g. HIPAA forms, insurance validation, COVID symptoms, etc.)  
• Patient Text message: “Click here to pay your bill” They’ve guided you to the page where they can see the charges, the insurance applied discounts and their resulting out-of-pocket costs.  
• Member snail mail or email: “View your explanation of benefits” – Payers often are later to the party and text is not a commonly used channel. 

One could argue that seeing the detailed EOB come isn’t that compelling unless you’re in sticker shock with your portion of the claim. The bill from the provider who is anxious for you to pay, already came and shows what your health plan paid.   

How can a payer become more relevant to their members?  

Know that they’ll never compete on the trust meter with the providers. Providers are paramount in health plan decision-making. Where does that leave the payer?  

Be specific and timely.
Show up as early and as often as possible to your member and treat them like a consumer of any goods or services. Payers focus too much on showing you what happened after you sought care through an explanation of benefits (EOB) and not enough before you seek care. Providers seek pre-authorizations from payers to ensure members have health plan coverage on more costly procedures. This is your moment, payers. Be proactive. You know that your member has OPTIONS for that care that vary greatly in cost. Make this known to the member. And get moving on a sophisticated preference center to help you reach them as soon as possible through the channel of their choice. 

Don’t bury the top 3 tools members need. Instead, extend them for greater use. 

• Find a Doctor, find costs for Rx, and find costs for procedures 
• Don’t be shy with your tools and think the only place for them is within an authenticated portal or app. If a payer is suffering from low portal usage, why not make it easier to get the member to these top tools from your public page. Enter your Group Number and off you go. 
• Drive growth: Also do not think of these tools as ‘member only.’ Imagine you’re a prospective member and you have two companies’ plans to choose from. Are you going to choose the one who gives you all the real costs for known prescriptions and upcoming procedures or the one that won’t expose that content to you? Build trust if you want that slice of business.  

Imagine this: 

I prefer text messages to other channels. My health plan asks me what level of content I’m comfortable receiving via text. My health plan sends a me a text that says, “We see that your <insert dr. name here> has referred you for a foot surgery to <insert surgeon name here.> That surgeon is NOT within the health plan’s network. We suggest these three in-network options for you (graphic compares docs and costs). <I select one.> Given where you are in your plan year, you’ve met your deductible and your out-of-pocket cost would be X$$. Click here to make an appointment.”  

What might ultimately happen with all this price information being shared?  

From a B2B perspective, there’s no doubt that savvy brokers are already using the publicly posted “Top 500 procedure” files to put pressure on payers during new sales and renewals. Payer C-suite executives have also responded to surveys indicating that they’ll conduct analysis of prices in their market and adjust to ensure competitiveness.  

From the consumer perspective, this will finally give individuals a better sense of cost to help drive important health decisions. The quality metrics are not yet integrated, but I see that happening at some point to give a future integrated score. At that time, the health plan should suggest high value (cost and outcomes) to their members.  

Our Digital Healthcare Strategy team helps payers better understand their audiences and create tools that drive action and inspire constituent satisfaction.

Contact us today for more information.