One of the most powerful lessons health plans have learned is that the ability to engage quickly and effectively with new members is a critical factor for a plan’s success. There is a crucial window of opportunity when new members join a plan; a kind of “golden hour” (to borrow a clinical concept) when effective engagement programs based on accurate data can dramatically impact the trajectory of high-utilization members. Organizations that can do this effectively in the first 30 days can have a significant impact on individual outcomes and reduce the overall cost of care for target populations. 

A recent study found that 80 percent of health plans place consumer engagement as a high priority, a remarkable consensus driven by many factors beyond curbing costs for high utilizers. Competitive pressures for market share and changing consumer expectations also are driving health plans to provide a much more sophisticated member experience, as is a desire to demonstrate to their customers that they know them and have tailored specific services to meet their needs.

Because of legacy technology, decades of acquisitions and consolidation, and a traditional focus on employer-sponsored programs, health plans have generally found it extremely challenging to acquire and analyze new member data and deploy appropriate engagement strategies to reduce costs, improve outcomes, and deliver a higher-quality member experience. Insurer data tends to be locked in silos associated with specific plans, making it difficult to normalize and analyze. Further, insurers often lack the resources to effectively deploy customized engagement and management programs. 

To engage earlier and more effectively, insurers need tools and data that allow them to expand their onboarding process to include “pre-boarding” analytics. This means accessing data at enrollment and assessing which new members have critical needs (e.g., no primary care physician, pending procedures, critical prescriptions) before their coverage even begins. The pre-boarding process also can include looking at social determinants of health, including non-claims data sources relating to income, geographic hot spots, transportation resources, safety and security, access to nutrition, etc.

While pre-boarding members may sound like an overwhelming task, the smart use of technology can be a real force multiplier when it comes to deploying outreach with limited resources. For example, automated communications programs can do the majority of member outreach, saving care managers for cases in which direct patient contact is necessary. 

Acting early and effectively also enhances the consumer experience, drives brand loyalty and influences a member’s willingness to engage in care. When health plans employ early engagement outreach based on an accurate profile of the member’s medical conditions, demographics, and stated preferences, it creates a much higher level of confidence and trust in the plan. Personalized outreach helps a health plan build a deeper bond by positioning itself as a true partner in improving the member’s health.

Rapid and effective new member onboarding and engagement is especially critical in government-sponsored programs, such as Medicaid managed care, Medicare Advantage, and Marketplace plans where members tend to have a backlog of postponed care. These techniques—which facilitate cost containment and improve clinical outcomes and member satisfaction—are especially critical for plans seeking to build successful business models in these markets. 

Developing the capability to effectively take advantage of this early window of opportunity can seem daunting to health plans, but effective engagement with healthcare consumers can only help improve patient experience and create a more seamless path to care.


Cynthia Nustad is executive vice president and chief strategy officer, HMS, Irving, Texas.

Publication Date: Thursday, June 21, 2018