As insurers continue to implement value-based programs, including patient-centered medical homes and accountable care organizations, they should get to know their members better.
Knowledge of their membership allows insurers to gather intelligence. For example, premiums and reimbursements must be properly configured for PCMHs and ACOs to succeed. But without insight into their member populations, payers can't appropriately set those amounts, reported EHR Intelligence.
"There isn't one-size-fits-all just like there's not one type of consumer or patient," IDC Health Insights Research Director Deanne Primozic Kasim told EHR Intelligence. "It's really about trying to reach people by respecting their different healthcare literacy overall, their social use of technology, their access to technology, and what's going to hit home with them because there are different messages and cultural and demographic concerns as to how to reach people."
Members are key to the success of value-based programs, which gives some insurers the upper hand in understanding the needs of patient populations.
"The ones that have more of a target population, such as the Medicaid and Medicare Advantage plans, have an advantage over the larger national plans because their patient population is a lot more focused and more centered geographically as opposed to those plans that are trying to cover everybody in different market segments," Primozic Kasim said.
Insurers should look at the Centers for Medicare & Medicaid Services and its approach with the Medicare Shared Savings Program and Pioneer ACO Model for guidance.
Getting to know health plan members also will help insurers boost their relationship and build brand loyalty with newer enrollees who signed up through the health insurance exchanges, FierceHealthPayer previously reported. That's why Cigna is harnessing data like Wal-Mart to better understand members. "There's data for data's sake and then there's data that actually has meaningful impact in what people will actually do," Joan Kennedy, Cigna's vice president of consumer health engagement, previously told FierceHealthPayer.
To learn more:
- read the EHR Intelligence article