Editor’s Note: This is Part 2 of a blog series on digital transformation acceleration in the healthcare industry. Part 1 examined the growing trend toward healthcare consumerism and a digital-first, personalized healthcare experience, especially with today’s empowered consumer changing daily behaviors.
Medicare Advantage (MA) programs provide a window into the healthcare industry transitioning to a value-based care (VBC) reimbursement model that prioritizes preventive medicine and managed care. The VBC approach conceptualizes a consumer’s health, lifestyle, relationships, and access to healthcare as a dynamic, holistic journey. By recognizing it as such and helping to guide that journey, the VBC model strives to lower overall costs and improve health outcomes and satisfaction.
Consider the Medicare Advantage adoption of new flex benefits in 2019, which include meal delivery, transportation, and home safety improvements for eligible beneficiaries, usually those with a chronic condition. Supplemental benefits based on a VBC model help explain the growing popularity of MA plans, which now count roughly 22 million beneficiaries, roughly double the number of beneficiaries of a decade ago, and about a third of all Medicare recipients.
With a capitation reimbursement of roughly $1,000 per month per MA plan consumer – and the average member staying with a plan for six years ($72,000) – the competition among private insurers which offer MA plans to acquire and retain members is fierce. There is also clear financial incentive to keep members healthy over the long-term, with plans becoming vested in the consumer’s healthcare journey.
Meet the Dynamic, Uncertain Healthcare Journey Head-On
I bring up this background in the context of the seismic upheaval to the healthcare industry caused by COVID-19. Overwhelmed hospitals and a sudden, general disruption change the calculus for how to market to and otherwise engage with confused and anxious healthcare consumers who are trying to chart a new journey amid an uncertain landscape. For MA plan marketers trying to acquire market share of the roughly 10,000 people available to be acquired each day, either by aging in (turning 65) or those switching plans, traditional methods of engagement – seminars, breakfast meetings, and other in-person events – have come to a halt. Seemingly routine flex benefits – transportation to an appointment, in-home meal delivery – become complicated.
These new challenges impact the entire healthcare community, and further accelerate the digital transformation in the industry and the transition to healthcare consumerism covered in the first blog in this series. These challenges further widen the gap between the healthcare experience a consumer expects, and what payers and providers deliver.
Overwhelmed providers must deal with the current health crisis, reallocating resources normally devoted to onboarding, care gap management, and education. Payers and providers are both challenged with communicating new information to the healthcare consumer, who often struggles with navigating benefits on a good day. Typical challenges – siloed data, unintegrated processes, a confusing matrix of access touchpoints – are exacerbated with an unprecedented health crisis that makes it difficult to know where to turn.
Foster New Partnerships with a Single View
To guide the healthcare consumer through new, dynamic situations requires data. A single view of the healthcare consumer is the foundational requirement that provides payers and providers a capability to form new partnerships that break down the traditional data and process siloes largely responsible for a disjointed consumer journey. With a single point of control over claims and clinical data, as well as behavioral and preference data, healthcare professionals are empowered to guide a healthcare journey with a focus on achieving the VBC goals of improved health outcomes and satisfaction with lower costs.
The ability to deliver a personalized consumer experience is one advantage of possessing a single view of the healthcare consumer. By knowing everything there is to know about the consumer, healthcare professionals can communicate in the right channel, optimize engagement, and become a more trusted caretaker able to walk hand-in-hand with the consumer throughout a dynamic journey.
The Tangible Advantages of Personalization
I brought up Medicare Advantage at the outset to showcase the example of one Redpoint client which ran a pilot campaign to gauge the effectiveness of personalization, with significant results. For this MA acquisition initiative, the client partnered with a health plan and value-based care provider, using relevant data from both the payer and provider side to match MA prospects with providers that were the best fit for an individual consumer, based on the consumer’s profile. It matched, for example, Spanish-speaking consumer with Spanish-speaking providers by closest location. And, it matched prospects with specialists treating the consumer’s specific condition. Personalized communications (emails with video’s, postcards, direct mail) were sent directly from the provider, rather than the usual genericized messaging from a payer that normally only tout plan benefits and offer little in the way of differentiation.
The payer ran this innovative pilot program for a select few zip codes, resulting in a significant ROI and an increase in acquisitions. By combining traditionally siloed data, this one pilot program forged an innovative payer-provider partnership to the benefit of both, and importantly resulted in a better experience for the healthcare consumer, in this case the new MA members presented with an innovative onboarding experience. Having a provider reach out directly is a compelling message, but it can only be done with the right data in place. Increasing dynamism in the consumer healthcare journey provides a powerful incentive for healthcare professionals to close the gap between what the consumer expects and what is currently being provided.
Redpoint and Lucerna Health will co-host a webinar, “Payer Marketing in a Challenging Environment” on May 13 that will cover many of the topics addressed in this blog. The second in a series on healthcare consumerism, the webinar will touch on the impact of social distancing on this year’s marketing campaigns, the impact on providers, and how to optimize personalized offer journeys in an increasingly digital marketplace.
Register here for the webinar, which will be held May 13, 1 p.m. EDT.