In an ideal world, we could compare the relationship between health plans, providers and patients to that of marshmallows, chocolate and graham crackers: the perfect blend. But in reality, they’re more like condiments, cupcakes and cabbage: They don’t go very well together.
The discord is not any single stakeholder’s fault. Lack of standardization, coverage restrictions, administrative complexities, and the shift away from fee-for-service care (among other reasons) have culminated in the failure to deliver a consistently seamless care experience across the care continuum.
This situation has worsened since the onset of the pandemic in the United States. Half of consumers are postponing care post-COVID because it’s difficult to find, access and pay for, a recent healthcare survey found. Meanwhile, the sharp drop in preventive care seen during the pandemic threatens to impact long-term health outcomes and costs unless payers can help redesign the care experience and convince members to seek needed care.
With much at stake, it’s clear that when it comes to member engagement, health plans need to step up their game, which raises questions: In a post-COVID world, where the consumption of healthcare has fundamentally changed, how do we meet consumer health expectations while helping payers and providers collaborate more effectively? And, how can health plans create a member-centric experience by leveraging technology to drive convenience, speed to insight and value?
To move forward, here are three ways that payers can support a more seamless, more personalized approach to care that boosts value.
Make care available on demand, where possible
The “consumerization” of healthcare has grown over the past few years as the release of smarter, faster digital devices normalized videoconferencing, mobile transactions and other activities previously limited to “in person” encounters. Consumers now expect the same speed and convenience with their healthcare experience, from the ability to text their physician with questions about their care, to remote monitoring of healthcare conditions and online access to laboratory and imaging results.
COVID-19, meanwhile, sparked the telehealth surge and a demand for safe, speedy healthcare. As The Coronavirus Aid, Relief, and Economic Security (CARES) Act eased barriers to virtual care, consumers flocked to telehealth – not just for urgent care needs, but also for behavioral health, chronic care management and more.
While in-person visits are slowly picking up again, there’s no going back to the pre-pandemic mindset, in which telehealth was leveraged as a stop-gap solution. A shift is underway where healthcare is migrating from episodic, face-to-face interactions to longitudinal care supported by a hybrid approach of in-person and virtual encounters.
Patients don’t want to worry about coverage each time they log into their telehealth portal. Ensuring that patients can connect to the right provider with ease — whether to gain expert advice in managing a chronic condition or to consult with a specialist regarding a complex or significant diagnosis — will be more important going forward.
Incorporate remote monitoring devices into care
Today, a number of consumer wearables, from smartwatches to smart rings, are tracking biometric data, such as resting heart rate and circadian rhythms. More advanced applications, such as wearables embedded with AI chips, promise to keep high-risk individuals away from the emergency room. A 2017 heart study between Apple and Amwell, for example, demonstrated that wearing a smartwatch with embedded electrocardiogram successfully detected heart rhythm irregularities and connected consumers to specialists when they needed medical attention.
It’s time to think about how health plans can find ways to incorporate remote patient monitoring devices into care and save millions of dollars by preventing acute flare ups and hospitalizations. Effectively pairing remote monitoring with telehealth – for example, by connecting wearables to portals, so physicians are alerted to concerning trends – will empower providers to provide the right care interventions at the right time while enhancing the member experience.
Invest in analytic tools that predict patient risk
Business intelligence is a driver of clinical care, and it is proving its worth in 2020 by enabling healthcare providers and administrative staff to focus on population health trends and individual health risks. Health plans and employers already use health risk assessments (HRAs) to collect information that enables them to develop benefits programs that improve health and wellness and attract and retain top talent. By pairing traditional tools with more advanced analytics, plans will be better positioned to predict long-term problems and outcomes — and intervene more quickly. For example, the use of predictive analytics during telehealth visits can help providers prevent unnecessary emergency department visits and decrease readmission rates. Such an approach optimizes the care members receive while reducing costs.
A More Modern, Seamless Care Experience
Cultivating serendipity among healthcare’s key stakeholders is an audacious goal, but in 2021 and beyond, with consumer consumption of care forever changed by COVID-19, it is an important one to achieve. While health plans haven’t traditionally been the purveyors of telehealth, remote monitoring, and analytics tools, these technologies can make an enormous difference in realizing the goal of a frictionless healthcare experience for members and enhanced care value for all.
The editorial staff had no role in this post's creation.