How health plans can improve the member experience with consumerized data
It’s no surprise that many health plans are rapidly updating their models to improve provider data inaccuracies, allow members to find the right care, and avoid costly fines for non-compliant data. With phantom networks making recent headlines and incorrect data impacting patients’ ability to find care, health plans across the country need to act quickly to redesign their current data solutions to improve the member experience and reduce costs through automation.
In 2017, the Centers for Medicare & Medicaid Services (CMS) conducted a study of online provider directories and found that 46% of sites reviewed contained inaccurate information, leading to a lack of access to care. Although inaccurate data is a big culprit in patients’ ability to find care, patients still trust health plans to provide accurate information to help them identify the right provider, according to the 2021 JD Power US study Commercial Member Health Plan Study.
So what does this mean for health plans? Health plans have the opportunity to innovate their current data infrastructure to not only update provider data in real time, but also to improve the provider search experience to increase customer retention and satisfaction. members and ultimately help patients find better care.
The way to achieve this end goal is to consume the data. Consumerized data, in the case of health plans, would involve repurposing current products and services to model similar consumer experiences, think online shopping, for members. In short, health plan provider networks should display relevant provider information that allows each user to personalize their care decisions. In this article, I explore a few ways health plans can revert to this solution with their existing data. This approach, if done correctly, can help health plans provide more client-centric services that help patients find differentiated, high-quality care that meets their specific needs.
Single source of truth for data from multiple sources
More data doesn’t necessarily mean accurate data or better patient experiences. That’s what health plans are doing with this data that drives member retention and acquisition. Health plans should consider gaps in their current data as a driving force to refine their current infrastructure and tap into diverse data outside of traditional provider sources. This can help health plans position their provider search platforms as the single source of truth for provider information across a variety of data points. For this to happen, health plans need to leverage rich external data networks to pull data from different providers outside of phone numbers, emails, and addresses.
Because consumers know that health plan provider directories are not always accurate, they seek information from many other sources such as search engines, doctor rating sites, and social media. The rise of phantom networks and outdated provider data has created a frustrating experience for members and can lead to additional costs for health plans if a member goes to a provider who is actually out of the network and suffers unnecessary and costly procedures and services. Instead, data needs to be validated, synthesized, and distributed from payer to member in a clear format to help members make confident decisions about their care provider.
The rise of telehealth is a relatively new but also essential factor to take into account. Virtual care visits are cost effective for members, providers and health plans. An analysis conducted by McKinsey & Company in May 2020 suggested that offering virtual assistance for emergency care could reduce emergency room visits by 20%. Including information such as the availability of virtual care and improving the overall completeness of a health plan’s provider directory can position that directory as the only source of truth. This reduces the friction and frustration felt by members when they are forced to search multiple sources to determine if a doctor is truly taking their insurance or actually treating knee joint pain, rather than back pain.
Leverage machine learning to generate actionable data
Machine learning can be a health plan’s secret weapon when it comes to consuming existing data. Health plans can improve their provider information by pulling data from external sources – there is also a clear opportunity for plans to use this data to provide consumers with more personalized provider options.
In addition to phone numbers and addresses, health plans should expand their provider data to include considerations such as cultural background, languages spoken, specialized and targeted areas of expertise, and quality indicators. Health plans should also look to optimize their current provider search experience to allow patients to drive their provider search with personalized filters that include ratings and social/cultural parameters.
For example, if I’m looking for a provider that specifically treats joint pain, is located in Idaho, has 4.5 star reviews from other patients, and can speak Spanish, I may have trouble finding it exclusively through the provider. current account of my health plan. The data. However, if this health plan leveraged data informed by machine learning, I could have a much more seamless and accurate search experience.
Machine learning models would sift through thousands of search results and predict that Dr. Camila Velasquez who practices at 41 Broadway is the same provider as Dr. Camila Velasquez-Smith who practices at 41 W Broadway and no longer practices at 66 Main Street. Rather than seeing 20 similar results for the same person, I get an accurate, consolidated list of the information I’m looking for. The machine learning would also recognize the many terms and specialty areas that “joint pain” could be categorized into, and pull those results to make sure I see all the options available.
The results I get from a machine learning-powered vendor search are personalized, centralized, and filtered to match my quality expectations. As a patient, it saves me time, frustration and ensures that I am directed to the right provider for my specific needs.
Enrich existing provider data to enable members to make personalized care decisions
Data is not enough, unless it is personalized. Health plans can build credibility and trust with members by providing personalized provider searches like the example I shared above. With enriched provider data, health plans can provide members with more information that is personally relevant to their care seeking, improving member retention and increasing market share through enhanced member experiences.
The opportunity to innovate here only grows for health plans. According to JD Power 2021 US Commercial Member Health Plan Study, only 22% of members said their health plans were “innovative,” citing the need to improve digital channels for better customer engagement.
Research shows that when members see health care providers who share their cultural background, speak the same language, or reflect their experiences, their health care outcomes improve. Some states have taken a proactive approach for health plans to collect and share this information with their members.
Colorado, in particular, enacted the Colorado Options Rule on March 2, 2022, which requires health plans to collect demographic information, such as race, ethnicity, disability status, orientation sexuality and gender identity, with health professionals and registrants to improve the status of members. and vendor matching. This type of information is essential to enable data consumption and provide patients with an experience centered on their quality standards to identify the right provider.
Ultimately, health plans and members have the same goal: seamless navigation to the right provider in the network that best meets the member’s needs.
The current structure of health plan provider searches does not have to be the norm. Rapid consumerization in other industries has given health plans a model for leveraging today’s technology to personalize the patient experience. Patients are the ultimate winners as health plans aim to effect this change. For the first time, we can begin to see the network effects that empower patients with accurate and enriched provider data to facilitate more convenient, cost-effective, and high-quality healthcare decisions.