By Matt Adamson

In the ever-evolving landscape of healthcare, member engagement is a multifaceted, complex undertaking that encompasses fostering a collaborative, seamless relationship between health plan professionals, providers, and members. Technology is instrumental in making this happen, but first we must understand the challenges faced by care managers as part of the member outreach process.

Understanding member engagement and its challenges
When members are engaged in the care process, they are more likely to adhere to treatment plans, make informed decisions, and take proactive steps to manage their health. This leads to better health outcomes, reduced healthcare costs, and improved member satisfaction. However, challenges including behavioral health issues, low health literacy, the impact of social determinants of health (SDOH), and members’ expectations can hinder health outcomes. The good news is there are many strategies both health plans and providers can implement to overcome each of these hurdles:

1) Mental/Behavioral Health Issues
A World Psychiatry article states that “Individuals living with serious mental illness are often difficult to engage in ongoing treatment, and dropout from treatment is all too common.” This highlights how difficult it is to improve clinical health when a patient suffers from health issues such as depression and anxiety. While providing support, resources, and guidance is important, trust is key to effectively engaging these members. Providers and payers can build a foundation of trust through one-on-one communication, conveying empathy, and listening to the patient/member without judgment from the very first interaction.

Establishing trust can be very difficult to do over the phone and nearly impossible using online communication methods. When possible, health plans should coordinate an in-person meeting or video call before trying to establish a digital, self-service connection. From there, regular check-ins and effective care coordination will continue to establish trust that can be leveraged to do more.

2) Low Health Literacy
Health literacy levels vary among members, and complex medical information can be overwhelming for even the most informed patients. Healthcare professionals need to consider these discrepancies and ensure information is communicated in a clear and understandable manner. Content delivery can be tailored to the audience using plain language, visual aids, and interactive tools to improve comprehension and engagement.

A Health Social Work article says that “Low health literacy is highly prevalent in the United States, particularly among older adults and racial or ethnic minorities.” This not only impacts outcomes but also creates a barrier toward simply navigating the health care system. Filling out required forms, understanding insurance coverage limitations and benefits, and managing one’s medications all require some level of healthcare literacy so including this type of educational opportunity becomes a key aspect of any member engagement strategy.

Historically, all healthcare-related communication was delivered via phone, face-to-face or postal correspondence. While more costly than some of the newer, digital solutions available, these more traditional methods are still effective and appropriate for many people and should be included within a health plan’s toolkit to enhance member engagement, as applicable.

Still, for many members, digital educational platforms can support communications. Sending a link to a credible, well-conceived video that educates a member on things like preventative care is an easy, low cost, and effective way to impact health literacy. Many solutions are integrated with population health management platforms to provide a seamless experience between the health plan and member. This outreach can be accomplished either as a one-on-one experience where a health plan care manager ‘sends’ content to the member individually or via the identification of population cohorts who all need to receive the same educational content.

3) The Impact of SDOH
Engaging in one’s health is lower on the scale of importance than finding food for their next meal or a roof over their head. If these issues are not sufficiently resolved, it is difficult to get a person to ensure they have not forgotten to go to their doctor appointment or fill out their health risk assessment.

Street medicine may be required along with the documentation of SDOH such as food insecurity, homelessness, and transportation challenges so that appropriate interventions can be implemented. In these cases, it is important for the care manager to gain trust and help people solve their basic problems first, so they can be enrolled in the more typical phone or digitized communication experiences once they are on better footing.

When it comes to the actual engagement with these members, it is important to note that the ‘digital divide’ is also being considered as an additional social determinant of health. This NPJ Digital article says that “greater reliance on digital tools has the potential to increase disparities between those who have skills and access to digital tools and those who do not and thereby existing health disparities.” It also goes on to describe digital literacy as a “super social determinants of health.” This means that tools such as portals, apps, online health literacy solutions, and telemedicine will not likely have much of an impact for those within the divide, so using a combination of solutions, including ‘boots on the ground,’ might provide the most promise.

Health plans can achieve optimal results for at-risk members by using a mixture of data, analytics, business intelligence, and efficient clinical workflows. Mapping SDOH at the census-tract level, finding opportunities to impact populations of members who live close by with the same issues, and developing programs for effective outreach in the community are critical.

4) Members’ Expectations
Healthcare consumers have grown to expect the technological capabilities that impact the way they shop, engage with financial institutions, and interact during personal relationships. Some like to talk by phone, and others want to engage solely online. Those partial to digital engagement still have preferences regarding how they use technology to interact with the rest of the world, and care managers seeking to improve outcomes need to adapt their tools and approaches accordingly.

Health plan care managers are in a great position to help members take advantage of available resources and services to support maximum health at a lower cost, but they need the right tools to successfully assess where a member is in their healthcare and put them on the proper care pathway. Individual- and population-level communications that leverage AI and prescriptive analytics capabilities allow care managers to manage, document, and report on members’ care adherence and outcomes. Once they have implemented the proper IT, it is up to the care manager to develop and execute best practices to ensure closed-loop communications such as:

• Follow up outreach using the member’s preferred communication channel
• Options to use portals and apps for self-management and health education
• Texting prior to planned phone discussions to increase appointment adherence
• Use of digital language translation services

Maximizing efficiency
Kathleen Ellmore, Co-Founder and Managing Partner of Engagys, says that her clients are looking for help so that they can touch more members and be more effective with their engagement strategy.

“In our work at health plans of all sizes across the country we see Care Managers who are frustrated because they are not given sufficient time to do what they do best – actually deliver care. Instead, they are saddled with administrative duties and primitive tools. Their demands are simple: provide them with adequate capabilities and seamless transitions into multichannel interactions including SMS text messaging, because it:

1. Builds on the behavioral science tactic of mental mapping
2. Reduces fear of spam, increases likelihood of answering
3. Increases trust in the message/messenger”

SMS texting can provide a major impact as part of a multi-faceted approach including tools such as email, U.S. Postal mail, portals, apps, artificial intelligence and more. Health plan professionals can optimize their tactics by adopting best practices such as:

• Tracking member communication preferences and having systems that can engage at the individual- and population-level based on those preferences
• Addressing cultural and language barriers through targeted outreach from care managers and automated, population-level capabilities of a care management platform
• Providing continuous educational experiences that are automated
• Actively involving members and healthcare professionals as new modes of engagement are implemented to ensure continuous improvement and member buy-in

By understanding challenges, implementing the right technology and best practices, and continuously evaluating and refining, we can significantly ultimately enhance engagement and drive positive results while reducing costs across the healthcare ecosystem.

About the author: Matt Adamson serves as vice president of product planning for ZeOmega and has more than 25 years of health information technology experience. He works closely with client executives and prospects to ensure product satisfaction and stay ahead of the technology curve, allowing ZeOmega’s product teams to proactively forecast and translate customer needs into new product development.