When Data And Technology Have Impact At The Health Inflection Point

Health plans have historically struggled to deliver personalization that increases member engagement, improves care coordination, drives better outcomes and reduces costs. That’s despite spending 10% or more of their administrative budget on care management, according to McKinsey & Company, which also explained that payers are not deriving a return on investment from such programs. [1] As a result, health plans have missed opportunities to engage members outside high-risk populations, primarily because the technologies to achieve mass personalization were not adequately robust.

Turn those findings around: Health plans now have an enormous opportunity to both improve personalization and drive ROI – and, unlike in the past, new care management technologies are accelerating the critical shift toward elevated engagement. But the emergence of digital care management platforms also means payers must harness data for mass personalization or fall behind competitors that are already achieving tangible results.

To gain a competitive advantage, health plans can expand the reach of care management teams by enabling them to move beyond member engagement into activation and stickiness by:  

  • Managing technology and data as imperatives
  • Meeting growing consumer demands
  • Navigating the new personalization landscape
  • Elevating member engagement with mass personalization

Managing technology and data as imperatives
Health plan CIOs rank customer experience as one of their top three 2023 priorities, alongside overall growth and technology modernization, research from Gartner found. [2]

By leveraging “advancements in technology and data,” leading health plans are delivering “truly personalized care on a scale that could not have been envisioned just a few years ago,” according to Boston Consulting Group. The results BCG highlights: payers are improving customer experience by 10%, reducing administrative costs by 10% and increasing quality standards by 25%. [3]

Leading payers are leveraging new advanced digital care management tools to refine the member experience with personalized care that bolsters engagement and care coordination, improves outcomes, establishes credibility and trust with members, and can be deployed quickly with low up-front financial risk.  

Meeting growing consumer demands
Today’s consumers are placing a higher priority on their own wellness than ever before but also increasingly dissatisfied with the healthcare they receive, McKinsey found. [4]

With digital care management platforms now available, health plans have opportunities to close that disconnect by continuously engaging and activating members with easier access to health resources and the tools to understand available options based on their unique needs.

Modern, dynamic engagement initiatives that enable seamless data-sharing across payers, providers, members, caregivers and families advance personalization with behavioral science best practices to deliver next-best actions that drive health improvements.

Navigating the new personalization landscape
Rising consumer demand for personalization leading up to and during the COVID-19 pandemic has dramatically re-shaped healthcare. [5] But the data health plans have amassed, which Kaufman Hall found outpaces healthcare providers, means payers are well-positioned to build member-facing experiences. [6]

Leveraging precise, up-to-date information, however, will require health plans to implement digital care management tools with core capabilities for: real-time access to data; instant personalized digital outreach to members, care teams and populations; and the flexibility to adjust care plans without IT or technical expertise. 

Advanced care coordination platforms enable health plans to automate administrative tasks that ultimately amplify the impact of care managers, population health managers, and marketers.

Elevating member engagement with mass personalization
Health plans simply cannot increase engagement without personalization. Individual personalization at scale sets a foundation for mass personalization, or the ability to quickly create bi-directional omnichannel outreach campaigns that are personalized to populations – driven by interoperable platforms, data engines and workflows capable of targeting populations by a number of demographics.

Mass personalization comprises a variety of components for both members and care managers. For members, that includes: content that resonates with individuals to enact behavioral science-based education, dialogue at the health inflection point via the member’s preferred channel in real-time when pivotal decisions are being made, and data-driven recommendations for next best actions.

Care management teams benefit from mass personalization with a comprehensive view of patient data, including social determinants of health, that can be leveraged to orchestrate result-oriented campaigns for specific member profiles, whether high-risk, rising-risk or low risk populations.

For both sides, human-centric approaches in today’s digital age also enable health plans to maintain the trust with and between members and care teams that is earned by offering technologies and leveraging data to their benefit.

Preparing for a future with even more personalization
In its most recent Global Strategy on Digital Health, The World Health Organization recommended that healthcare institutions continue maximizing digital innovations to improve care quality. [7]

Health plans that deploy platforms that are scalable with personalized interventions and automated workflows to drive growth, manage risk and optimize administrative functions, will consistently captivate members spanning various backgrounds and geographies in the paramount shift to personalization.

About Medecision
Medecision delivers a data platform, next best action engine, and automation — all fed directly into care manager workflows when needed. These capabilities unveil pivotal insights across a vast member base, ushering in true personalization – at scale. As modern consumers set their sights on this caliber of service, data-driven personalization emerges as the standard for health plans.

[1]The untapped potential of payer care management, McKinsey & Company
[2]2023 CIO Agenda Insights for Healthcare Payers, Gartner
[3]Delivering on the Promise of Personalization in Health Care, Boston Consulting Group
[4] Consumer Health Insights: How respondents are adapting to the ‘new normal’, McKinsey & Company 
[5]Digital health in the era of COVID-19: Reshaping the next generation of healthcare, Frontiers in Public Health
[6] 2022 State of the Healthcare Consumer Report, Kaufman Hall
[7] Global Strategy on Digital Health, 2020-2025, The World Health Organization

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