Using digital tools to alleviate fear and drive engagements

Improving health plan communication and integrating the member journey

Lesa is the global practice lead for consumer solutions in NTT DATA’s Health Plan Solution team focusing on digital innovations for health plans. She has approximately 35 years of leadership experience in healthcare, group benefits, health plans and consulting. In her role at NTT DATA she is has led the development of an integrated Digital Health Platform that gives health plans, providers, brokers and members the tools to needed to make better decisions.

How can payers ensure they continue to stay engaged with their patient population during the pandemic?

LB: We can do this by bringing digital tools into the conversation and bridging data sources that tell us what’s happening with a member. Utilizing data obtained via digital tools can help us understand the consumer’s behavior and bring additional perspective to their care plan. One of the ways we can ensure we have a full picture of the member is by ensuring patient data moves with them as they switch health plans. Amid the pandemic, CMS issued a final rule, CMS-9115-F, that will require data to be shared between healthcare providers, health plans, and all other constituents so an insurer can follow an individual member throughout time. Before the rule takes effect next year, leaders need to ensure they are in compliance and using FHIRcompliant platforms.

Managed care organizations have an incentive and responsibility to ensure that patients are making healthy choices and seeking appropriate, proactive care. What best practices can you share for engaging these patients?

LB: One of the most effective ways to do this is through mobile apps and digital technology. Leaders should make sure these resources are available not only to their member population, but also to those in the community who are not currently members and could benefit from the outreach and engagement. Apps can be helpful in linking members to local organizations that address social determinants of health, as well as provide health education content that plays an important role in driving patient behavior. Health plans can make this content more meaningful for members by leveraging data to identify individuals with specific needs and serving them personalized content that addresses those needs.

How should payers and providers engage patients to assure them that care can be delivered safely?

LB: Pre-visit engagements such as digital questionnaires and virtual check-in can alleviate patient fears and allow them to wait for their visit in their car, distanced from others. Practitioners should also ensure they’re sending out information that details the steps they are taking to ensure patient safety, and if possible, staff should walk the patient through the protocols via direct phone outreach. Communication is key — we want patients to seek the care they need and not delay it.

What is the role of AI in enabling productive care interactions in this virtual new normal?

LB: Data-driven decision-making is more critical than ever. Value-based care contracts are quickly becoming the new normal, so leaders need to be able to capture outcomes across their patient populations. Predictive analytics can help leaders evaluate providers and closely monitor population health. From a consumer experience perspective, AI-informed chatbots can play a significant role in alleviating pressure on call centers, while recognizing dissatisfied consumers and escalating their case to a live representative. This is particularly important with older adults who may not be comfortable with a chatbot.

As patients visit their doctors less, how can organizations continue to effectively manage complex cases?

LB: A consumer engagement hub can help payers engage the consumer, allowing them to be proactive and engage in bidirectional communication. It can also help us set goals with members around a specific diagnosis, including interventions, barriers, outcomes and personal goals. Having the patient and their care team involved enables a dialogue and allows everyone to manage expectations, which is important. The care experience is currently disjointed—some organizations have websites you have to visit for different purposes, such as billing or lab results. Disparate systems create a disjointed view for the members, placing onus on the individual to navigate their own course throughout their healthcare journey. This additional responsibility can be a heavy burden for someone who isn’t feeling well—we should use technology to integrate the entire member journey.