Healthcare consumerism is a movement that recognizes the healthcare consumer as empowered to become more involved in their healthcare decisions. It defines and prioritizes an overall healthcare journey as more than the sum of its parts, meaning an individual’s interactions with a health insurance plan and healthcare providers do not paint a complete picture of an individual consumer. Factors such as social determinants of health also weigh heavily on a consumer’s predisposition for long-term health.
With healthcare consumerism gaining traction, there is an accompanying shift to a value-based care (VBC) operating model, where payers and providers have are financially aligned to keep consumers healthy by managing the overall healthcare consumer experience, rather than be rewarded on a fee-for-service system that is less sensitive to an individual healthcare consumer journey. The goals of a VBC model are to reduce cost and inefficiencies, improve health outcomes and improve overall patient satisfaction.
Redpoint Global Chief Marketing & Strategy Officer John Nash recently spoke with Lucerna Health CEO and Co-Founder Craig Thomas about healthcare consumerism, what it means for payers and providers and its overall impact on the healthcare space, and the disruptive impact of COVID-19.
John Nash, CMO Redpoint Global: Craig, in the past few months we have seen a rapid acceleration of digital transformation initiatives across all sectors, companies responding and adapting to COVID-19 and its effect on consumers. What are the implications in the healthcare space, more from the perspective of engaging with the consumer rather than the direct health crisis itself?
Craig Thomas, CEO Lucerna Health: As you know John, there’s a lot of uncertainty and safety challenges for patients and front line providers. Safety is everyone’s top priority. If this is a new normal, we see health, social and financial concerns that all impact how payers and providers will communicate and engage with consumers. From the health perspective, there are concerns about access to primary care, delayed or foregone screenings, and long-term isolation concerns that can impact patients mental health. Social concerns include the impact on in-person doctor’s visits and the other social distancing ramifications. Financially of course there’s concern about affordability, particularly for seniors and caregivers, as well as higher unemployment and loss of employer-based coverage. There are also significant financial pressures on healthcare providers, particularly in a fee-for-service environment.
Optimizing healthcare consumerism requires a deep understanding of the issues facing payers and providers. It’s why payer and provider integration is so important for optimizing results in a VBC arrangement. Without that integration, data about the healthcare consumer is siloed and it becomes difficult if not impossible to engage with the consumer in a personalized way that recognizes their healthcare needs and their individual journey, which as you know has a direct correlation to increased health outcomes as well as business results like revenue lift, and higher retention and conversion rates.
That is what we have been doing, helping healthcare organizations grow and succeed together in the rapidly evolving healthcare marketplace, implementing industry-leading omnichannel technology and using data-driven marketing and engagement services to enhance their offerings to patients. Integrating operational insight is so important to allow our clients to respond effectively in this challenging environment.
JN: You lay out the benefits of having a single platform for healthcare organizations to deliver innovative customer engagement, which speaks to the recent extension of the strategic partnership between Lucerna and Redpoint. What types of experiences are your payer and provider customers looking to implement?
CT: The challenge is navigating consumers to high-performing providers, engaging patients and then coordinating services and programs to support the member/patient. This is the high-value customer journey.
Individualized and contextually aware education becomes very important. Are you letting a customer know about a change in services, for example, different hours of operation, more staggered appointment times? The goals and challenges of a VBC model are similar, but what changes are how you manage them in this environment. You must re-think your value proposition; how are you meeting your customers’ primary needs?
There’s a shift from a “we’re here for you” message to “let us take care of you” from a broad health perspective that’s centered on an individual consumer more than core benefits, or even healthcare delivery. There is a big push to engage digitally and emphasize virtual benefits such as connecting a customer directly to a provider’s digital scheduler, including telehealth services. A consumer that is more connected digitally and more driven by knowledge will usually result in a simpler, safer experience.
JN: You’re talking about enhancing a personalized healthcare experience, which as you mentioned is made possible by integrating provider and payer data and having a single view of the healthcare consumer. What are some other effective examples of personalization?
CT: Yes, personalization across all engagement touchpoints is critical. If you know in an automated and scalable way driven by data and analytics the last provider a patient saw – which location did they visit, what are their health conditions, social determinants of health, drive times from various centers – now you’re in business to personalize which means relevance which means lift. But you need real-time decision-making and real-time integration with the EMR (electronic medical records). If you’re running a campaign to drive a member to a primary care physician and you start with an email and they go ahead and set an appointment, you’d want to know that so you don’t create abrasion and confusion by continuing to communicate with them.
Having the health plan data (e.g., claims and benefit plan) is also a critical element. For example, if the member can save money by seeing a particular high-performing provider, we can highlight this to the consumer when communicating to them via campaigns. Having both the health plan and provider data and integrating operation insight can really drive results for forward-looking payers and providers, particularly those that value primary care alliances and VBC principles.
Another example is we are able to include a message that says “at no cost to you” in a personalized email from a provider to a member that’s been assigned to them to try to schedule an appointment. We can do that because we know the details of the benefit plan that consumer belongs to. That no-cost message obviously removes a key scheduling barrier. It’s a simple example of some of the things you can do with a strong platform that drives real, measurable economic results and proves ROI at a use case level.
