Member Engagement Is a “Must-Have” in Today’s Health Plans

As the implementation of Health Reform progresses, the rate of change accelerates, as new funding, service delivery, and access models emerge. These provider adjustments should be excellent news for millions of Americans who need more help from the healthcare system, especially since many people with chronic diseases aren’t getting the care they need. When you consider that the majority of patients do not follow their medication and treatment regimens, as well as advised lifestyle and health behavior adjustments, it’s simple to see where some of the problems may arise.

This is where payers, particularly health plans, may make a big difference.

Health plans have immediate access to claims data and other clinically relevant information, as well as a direct channel to their members for targeted messaging and therapeutic interventions. Health plans have a big opportunity to assist promote behavior change, lowering risk, and achieving great health outcomes for their members, even if it isn’t a typical strategic priority. Most health plans currently offer member portals and other useful tools, and many have begun to focus on improving these activities and projects in order to increase their value and impact. They will, however, need to re-orient their attitude and strategy to be significantly more consumer-centric in order to compete effectively in a fast-changing market.

Consumer Influence

Healthcare Consumerism has begun to take root after a decade of modest growth. The number of people participating in high deductible health plans (HDHPs) is at an all-time high, with 23% of those with employer-sponsored insurance now doing so. Consumers will continue to gain more influence when new elements emerge, such as price comparison tools, quality evaluations, and retail health options. Health plans must adapt to this trend by developing strategic solutions for their member populations or partnering with best-in-class service providers. This places a larger emphasis on positive, relevant, and trust-building member engagement outreach and interactions.

This isn’t going to be easy. According to recent research, there is a significant trust gap between insurance companies and their customers. Only 22% of members regard their health plans as a “reliable source,” according to a KMB Group poll of 34,000 consumers. This compares to an average of 80% for doctors.

Participation of Members

Most health plans are new to member engagement, and with Medicaid expansion, the flood of age-in Medicare members, and the newly insured, it’s more vital than ever to deliver consumer-oriented communications, interactions, and interventions. Health plans will find themselves striving for excellence in customer experience through outstanding member engagement as Star Ratings and other quality measures gain traction and consumer brand preference and loyalty become more critical criteria. In order to establish an effective member engagement plan, we notice a few issues that need to be addressed:

  1. Gain a better understanding of how customers think and act in their own health and healthcare environments.

Health plans must perform an in-depth and candid examination of their member outreach, as well as any and all ongoing interactions, the customer support function, and related areas. This is a necessary first step toward lasting transformation and can aid in the discovery of consumer decision-making patterns. Behavioral economics, for example, provides many significant lessons and can serve as an excellent guide for developing a message plan for members.

  1. Implement a member-centric marketing strategy that is tailored to their specific issues and interests. Health plans must become a valued partner by building a communications strategy and outlining quantifiable actions with a consumer marketing perspective. All member touch points and areas of outreach must contain strategic messaging. Too many health plans still use dated letters from their Chief Medical Officer to introduce a variety of health-improvement programs. Remove them and replace them with content that is meaningful, relevant, and trustworthy to the recipient.
  2. Align and integrate all health improvement service offerings strategically.

Most health plans can check all of the boxes in terms of wellness, care management, disease management, pharmacy coordination, and a variety of other services, but integrating them all together in one seamless solution is what members really want and need. These are some ideas on how health plans might improve their capabilities to become more member-centric and engagement-oriented. They can do a lot to influence member behavior, reduce risk, and contribute to better overall health outcomes, all of which should result in higher margins and returns. Many consumer marketing methods from other industries can be learned and adopted by health plans, all of which can help to generate more positive experiences in healthcare. The victors in a consumer health plan market will almost certainly be those who thrive at member involvement.

What Does It Mean to Smoke?

Inhaling the smoke of burning tobacco in the form of cigarettes, cigars, and beedis is referred to as smoking. Whether you smoke once in a while or on a regular basis, you will be classified as a smoker under the terms of your health insurance policy. Smokers can obtain health insurance, but depending on how many cigarettes they smoke on a regular basis, an insurance company may charge a higher premium or deny your application. A smoker may also be required to undergo additional health examinations that will assist an insurance provider in determining the risk factor and charging the appropriate premium amount.

The Effects of Smoking on Your Health and Insurance Premiums

Smoking has a number of negative effects on your health, some of which are listed below.

Circulatory System: Smoking raises the risk of heart attack and high blood pressure. A buildup of fatty acids may lead to atherosclerosis. Smoking damages the immune system and causes serious and long-term disorders. Ulcers, cancer, pneumonia, high blood pressure, bronchitis, and various viral/bacterial/fungal diseases are more common in smokers.

Lung Functions and Breathlessness: Smoking can harm lung functions and cause breathlessness. It has the potential to harm the lungs’ air sacs, increasing the risk of chronic bronchitis.

Oral Health: Smoking can cause tooth loss, discoloration, and gum disease, all of which can lead to dental decay.

Cancer: Smoking for an extended period of time causes cancer in a variety of body organs.

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