Jan 18, 2023
Closing gaps in care with a healthcare CX platform
9 min read
How a CX platform helps payers close gaps in care for high-risk members
Individuals with chronic diseases and mental health conditions account for 90% of the U.S.’ $4.1 trillion annual healthcare expenditures¹. Closing gaps in care for high-risk populations is imperative to improve health outcomes and reduce healthcare costs. However, many payer organizations struggle to engage members and direct them toward better health.
The lack of member engagement is often due to the cumbersome, fragmented and episodic CX that characterizes today’s member health journeys. An increasing number of disparate point solutions, such as member portals, pharmacy benefits and telemedicine services, significantly contribute to the poor experience. These point products lack the ability to communicate with each other, causing data silos that limit insights into member health needs.
Research shows individuals who are less engaged are three times more likely to have unmet medical needs and two times as likely to delay getting care.
HEALTH AFFAIRS RESEARCH²
By designing the member experience around engagement, payers can direct members to the most appropriate treatment and encourage preventive care and disease management. An effective method of transforming an organization’s CX is to take a platform approach to the member experience.
Here’s how a healthcare CX platform impacts payer organizations and helps close gaps in care:
Provides a single place for healthcare navigation
An interoperable healthcare CX platform can bring disparate point solutions into one convenient location. From coverage information and claims management, to telemedicine and pharmacy needs, every aspect of the member’s healthcare ecosystem can be accessed through one digital platform. This makes it easy for members to find the care and support they need.
“The point solution approach of the past will not enable the digital and organizational transformation that is needed.”
ANDY TRUSCOTT
Global Health Technology Lead, Accenture
According to the Centers for Disease Control and Prevention (CDC), six in 10 American adults have one chronic disease and four in 10 have two or more chronic conditions³. Managing multiple conditions is difficult, and having various log-ins and systems only makes a member’s complex health management more challenging. Having a single, easy-to-use log-in for healthcare navigation encourages high-risk members to be engaged with their health journey and proactively manage their health.
The CX platform allows payers to become their members’ digital destination for care. By providing a singular trusted resource for members to access, navigate and pay for care, payers encourage members to consistently engage in their healthcare.
Delivers personalized, data-driven member health journeys
In addition to integrating point products, an interoperable CX platform aggregates various data sources — such as claims, electronic health records (EHRs) and wearables. By eliminating data silos, payers gain a real-time, comprehensive view of each member, and these insights can drive orchestrated, deeply personalized health journeys.
Payer organizations can leverage a CX platform’s machine learning (ML) and artificial intelligence (AI) models to deliver next best actions that account for members’ unique health needs. By identifying gaps in care and guiding high-risk members to the next best action, payers can reduce emergency department (ED) visits and acute care interventions for high-risk members.
Nearly 60% of annual ED visits in the U.S. were for people with at least one chronic condition and more than 4.3 million ED visits may have been preventable.
PREMIER INC. RESEARCH⁴
The ML/AI models built into a platform’s infrastructure also allow payers to develop tailored content and health journeys for specific populations. For example, members at high risk of lung cancer who are eligible or due for a screening can be prompted to schedule their exam and learn more about lung cancer prevention. Members with diabetes can be guided on a personalized diabetes care journey to ensure they have the tools, resources and support to proactively manage their health.
Helps members become active participants in their health
Typically, high-risk members need to attend appointments for treatment and disease management, but health outcomes are reduced whenever an appointment is missed. With a configurable, interoperable CX platform, payers can connect online and offline experiences and leverage predictive analytics to help members actively participate in their care.
Predictive healthcare analytics enable payers to guide members toward better health decisions and through an improved continuum of care. From reporting changes in symptoms or reading health content, to meeting with a clinician or refilling a prescription, payers can direct members to the actions, services and points of care that are financially responsible and improve the member’s health. A CX platform gives payer organizations the data, infrastructure and engagement tools to encourage high-risk members to manage their health and seek effective care in-network.
Closing gaps in care with a healthcare CX platform
The fragmented and episodic state of the healthcare CX creates barriers to disease management and prevention for high-risk members. By transitioning to a platform-based CX, payers can bring siloed point products and data sources into one location to deliver cohesive, data-driven member experiences. This enables payers to engage members 365 days a year, guiding them to the right care at the right time to close gaps in care and ultimately improve health outcomes.
To learn more about how a platform drives member engagement and better health outcomes, download our eBook with Becker’s Healthcare.
Becker’s Healthcare
Learn why the future of healthcare CX requires a platform approach.
¹Source: Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion: Health and Economic Costs of Chronic Diseases
²Source: Judith H. Hibbard and Jessica Greene; What the Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data on Costs; Health Affairs, Volume 32, No. 2 (2013): 207-214
³Source: Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion: Chronic Diseases in America
⁴Source: Premier Inc.; Ready, Risk, Reward: Improving Care for Patients with Chronic Conditions; 27 February 2019