As patient expectations rise and health policies related to Medicaid funding shift, it’s imperative for systems to balance more exacting reimbursement procedures against lower federal reimbursements so that they can maintain margins and continue to care for the people in the community who need it, regardless of their coverage.
Commercially insured patients are vital to the financial and clinical wellbeing of health systems. But often, they fall through the cracks, not because they lack care access, but because they lack a trusted connection with their system, which limits motivation to close care gaps, receive vital health screenings or attend annual wellness visits. For many health systems, disjointed patient data and fragmented communication channels prevent providers and staff from delivering personalized outreach that keeps patients informed, engaged, and loyal.
Poor Communication Comes with Risks
When commercially insured patients don’t hear from their provider they miss more than a message, they often miss care. Gaps in communication can lead to gaps in care, including uncompleted follow-ups, missed screenings, delayed procedures, and unfilled prescriptions.
Often, it’s not a lack of outreach that leads to missed care encounters. Providers are sending messages to patients, but those messages are generic and impersonal. Without accurate, real-time patient data and the ability to send communications via a patient’s preferred channel (text, phone call, email, etc.), messages arrive at the wrong time, through the wrong medium, or with outdated information.
Why Commercially Insured Patients Deserve Special Attention
Over 65% of Americans receive their healthcare coverage through commercial health insurance. These patients often have the benefit of provider choice and therefore have higher expectations for convenience, personalization, and transparency. Historically, patients often sought care from the family medicine physician in their town as their default provider. But as time and technology have changed the healthcare landscape, patients are more empowered than ever to seek care from providers outside of their network that better fit their needs. Today, patients follow consumer trends and have the ability to research health systems and read reviews from patients online to inform their care decisions. In fact, nearly 75% of patients use online reviews as the first step in the process of finding a new provider. It is not a default decision for a commercially insured patient, it is one that takes time, effort and careful consideration.
Losing touch with commercially insured patients can result in increased care fragmentation, missed revenue opportunities, and erosion of patient trust and satisfaction for health systems. Given the importance of online credibility for this population, it is important to maintain trust and provide comprehensive healthcare to avoid downstream losses. In order to do so, health systems must communicate consistently with reliable, tailored messages to not only acquire and retain patients, but help guide them to the care they need, when they need it and help them understand the care options available to them within the health system.
For example, with the right context, providers can predict which patients may need future joint replacement care, and then proactively introduce them to a new joint replacement program, which they may not otherwise have been aware of. For patients scheduled to receive surgery, the right data also means the provider can provide the right pre-operative planning and support and post-operative rehabilitation options.
Data-Driven Communication to Keep Patients Engaged
To close care gaps and maintain loyalty among commercially insured patients, providers must move beyond one-size-fits-all outreach to enable truly customized communication. Effective communication depends on the ability to access and act on accurate, up-to-date context about each patient including where they are in their care journey, what benefits they’re eligible for, and how they prefer to engage with their providers. It requires more than clinical and claims data; providers must access consumer data, such as social, behavioral and engagement signals, from a single source of truth to truly understand a patient’s unique health drivers to motivate meaningful action.
When data is outdated or fragmented across systems, the best intentions can still lead to missed opportunities or confusing interactions. Data that is fit and ready within a single comprehensive patient profile enables organizations to shift from reactive to proactive communication. It ensures that the right message reaches the right patient at the right moment, whether a preventative screening reminder, a prompt to schedule a specialist visit, or guidance on a specific benefit. Achieving this level of precision and impact begins with a strong foundation of data readiness, ensuring that patient information is accurate, current, and unified across systems to support timely, relevant, and effective engagement. This work begins with a data readiness platform.
Better Patient Experience Starts with Better Information
Patients expect more than access to care, they expect providers to truly know them, to provide clear guidance in their care journey, and to communicate with them like they know them well. Every interaction is an opportunity to reinforce trust and loyalty in your health system, and by relying on optimized, up-to-date patient data, you are more likely to acquire and retain patients, effectively close their care gaps, and drive revenue for your organization.
By investing in data readiness for your health system, you can:
- Strengthen relationships and retain commercially insured patients
- Guide patients to the right care at the right time
- Improve clinical outcomes and close care gaps
- Reduce leakage by creating a cohesive, connected experience across the continuum of care
- Reduce downstream hospital admissions by addressing health concerns before they escalate
- Create a patient acquisition action plan by introducing community members to service line offerings and covert them to care
Reliable communication takes more than a call from the front desk. Having the right data can improve patient health and operating margins by keeping patients engaged with their health and your system.
Discover how Redpoint helps leading health systems orchestrate more connected, patient-centered experiences. -> https://www.redpointglobal.com/healthcare-providers/
