Health plans these days are investing time and resources in analytics and investigating new ways to more fully engage with their members. Why? Because engagement is correlated with better outcomes, and while health plans have millions of dollars at risk related to gaps in care, they have relatively few ways to address them. Member engagement is one of those ways.
Fortunately, member data sets are rapidly improving. These increasingly robust data sets make it possible for health plans to segment their member populations and tailor care plans based on such factors as demographics, clinical history, and consumer preferences. This type of data-driven, personalized plan design has all kinds of positive effects—on utilization, on outcomes, on patient satisfaction.
Not surprisingly, health plan interest in harnessing these data sets is growing because they can be used to support quality improvement, HEDIS, and Medicare Star rating performance, cost containment, and member satisfaction. The catch is that many don’t have the in-house resources to leverage their member data to the fullest. Three key areas will help plans to close gaps in care and improve outcomes.
Once member data have been aggregated and propensity models are in place, there are different ways health plans can further optimize member-engagement programs. Many health plans begin by targeting members with high-risk profiles and histories of low engagement. Starting with one segment is a practical place to start. More mature engagement programs will address the needs of all segments. If most of a health plan’s communications suit the needs of only one profile or segment, a significant percentage of the overall member population is likely to remain unengaged. Effective analytics enable health plans to understand their members’ needs in a more granular way so that engagement programs can be equally granular—and therefore have a large effect overall.
Informed member engagement strategies can drive member activation that, in high-risk segments, can have life-saving potential. Greater member engagement supports both health plan and provider efforts to close gaps in care, connecting members to the appropriate care in the care settings of their choice. Members are looking for a customized health care experience. With analytics, health plans can deliver it.