How Health Plans Successfully Implement a Digital Strategy

Health plans understand that their future success hinges on their ability to operationalize a digital strategy that meaningfully improves efficiency and member experience. Increasingly, these payers are implementing new technologies to bring services back inside the organization and achieve new levels of satisfaction among staff and members.

“If payers want to stay competitive, their ability to control their own destiny goes up exponentially the more they can interact with the member and control the experience the member is having,” says Doug Berkson, Vice President of Customer Engagement at Wellframe. “We want to empower payers to be differentiated in the market and to be innovative and to successfully engage and demonstrate positive impacts on their members.”

According to Berkson, successfully operationalizing a digital strategy requires health plans to focus on four key areas, beginning with looking at value and understanding goals. Organizations must also assess, understand, and align on the populations targeted for the digital program. They must ensure employee end-users of the technology are positioned for success. Lastly, it’s crucial to put strategies in place to reach, inform, and engage members in the digital health offering.

Buy-in and support are essential for getting the digital transformation project off the ground and running.

“Health plans are large, complex organizations. Without executive champions, a performance-oriented culture, or leaders, you won’t be able to clearly articulate and then execute on that strategy on a day-to-day basis,” Berkson notes.

Although health plans vary in their makeup, leadership often comes from the clinical side, either a chief medical officer or medical director focused on care management in a digital environment. However, these leaders are reliant on others from IT and the C-suite to secure proper support. “Everything starts with culture, leadership, and champions. Champions for new technology need to align stakeholders across the organization early on in the process,” Berkson adds.

Goals are likewise an important feature of a digital strategy. An obvious starting point for many health plans is return on investment.

“Many of our customers work with us to achieve goals such as quality improvements, cost reduction, and inappropriate utilization reduction,” Berkson says.

But many health plans have more specific goals in mind. For example, some payers have the simple goal of engaging more members.

“With digital engagement platforms, health plans have a much broader ability to penetrate their membership from a communication standpoint, so engaging can have a big impact,” Berkson observes. Such a focus could include targeting high-risk, rising-risk, or low-risk populations.

Differentiation in the market is another attractive goal for health plans. These payers could be competing for Medicare or Medicaid contracts where having digital capabilities becomes a difference-maker.

Additionally, digital member engagement tools must be suited to the needs of both staff and the populations they serve.

While a goal of a digital strategy may be the ability to increase caseloads, Berkson warns that health plans should not get too ahead of themselves, noting the importance of taking a step back and seeing the big picture.

“At Wellframe, we come up with staffing plans based on understanding and talking to staff end-users and assessing how they currently manage their caseloads because everybody has a different one,” he explains. “It depends on member mix and the members they are trying to target. For example, a care manager might have a caseload of 50. Another with a low-risk population of chronic conditions might have a caseload of 100.”

That difference is significant and must be taken into consideration.

“We have to make sure we understand that going in before setting targets for staff capacity. Perhaps the health plan sets a target of 10% of members on the digital platform after one month and 20 percent after two, before ramping numbers into the 40s and 50s,” says Berkson, who emphasizes the importance of taking pauses to ensure that staff are comfortable and can provide feedback about their experience.

Effectively putting into place a digital strategy allows health plans to rethink outreach and engagement and realize benefits in the near, mid, and long term.

“Health plans are going to start to see significant utilization of the platform from both a member and staff standpoint, literally within weeks, if not months,” Berkson maintains. “Compared to traditional care management, a digital platform allows members to onboard themselves into health management programs. So whether it’s typical snail mail, texting, or email, the plan can very efficiently send out information about how members can adopt the digital tool on their own, without too much assistance from staff members.”

The pandemic accelerated both the demand and adoption of digital health. With the right strategy, payers can not only implement digital solutions but ensure that new technology initiatives yield meaningful improvements in efficiency and health outcomes.

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Wellframe partners with health plans nationwide to reimagine member relationships. With solutions for care management and advocacy, the Wellframe Digital Health Management platform empowers health plans to become a trusted advocate for all their members' health needs. Learn more at wellframe.com.

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