Adopting a Member-Centered Approach to Digital Health Management

The coronavirus pandemic has proved to be a watershed moment for how healthcare organizations interact and communicate with American consumers. For health plans, the past year signaled a real challenge to traditional approaches to member engagement. It necessitated an aggressive modernization of their health management efforts to be well suited to an increasingly digital and virtual environment.

"Partly driven by consumer expectations and the evolution of tech adoption, health plans have come to prioritize these investments in modernization," says Wellframe CEO and founder Jake Sattelmair.

"That was already happening pre-COVID," he continues, "but in a world where people weren't able to see their doctors in person and everyone was forced into virtual care and telemedicine, it was a wakeup call that digital engagement and virtual support for members or patients is not this discretionary sidecar to the healthcare system, but a primary channel."

Simply put, a nice-to-have has evolved into a must-have for health plans. With consumers and employers expecting more from their health plans, payers must find ways to meet them where they are. For health plans, that means prioritizing innovation, mainly in the form of member-facing digital tools and services.

"Most plans recognize that the traditional models are being disrupted, and they need to be part of that disruption," adds Sattelmair.

"A number of our customers doubled down on our partnership so that they could play a more proactive role in supporting more of their higher-risk members through COVID, managing their conditions in periods of time in which it's harder for them to see their physician as well as giving them information about self-care, prevention, and managing some of the psychological challenges that are inherent pandemic life.”

Technology is an integral part of innovation, but it is secondary to meeting the needs of patients.

"Bringing the technology is a critical part of the equation," Sattelmair explains. "But helping our customers to drive through the change management needed to reorganize their resources around these new ways of interacting with members and shift their thinking and their strategy to optimize value is a meaningful piece of it as well," Sattelmair.

Technology must have an obvious purpose. In this case, it is in the service of a patient-centered approach to healthcare based on the specific needs of individuals with varying levels of health needs and goals to meet them.

"If we can make it easier for them to get their questions answered, find the support that they're looking for, and position the plan as a resource or an advocate to help people get their needs met, then that's a much better starting point for longitudinal care and support than having that first interaction being a denied claim," Sattelmair emphasizes.

Moving to modern digital health management

The pandemic provided significant impetus for change among payers. Health plans have the opportunity to lay the foundation for future success by investing further in digital health management regardless of their lines of business (e.g., commercial, Medicare, or Medicaid).

"The push toward virtual care really accelerates many of those opportunities," Sattelmair notes. "Now, you see plans introducing virtual primary care-first products. You then begin to see all the resources that the plan could bring to bear, bringing together primary care, customer service, and care management right there in the same digital channels. That's a future that we're looking to be part of."

Key to this success is a focus on relationships between the member and the health plan. According to Sattelmair, technology for engaging people at scale often falls short for failing to understand the needs of members.

Shoring up existing service lines and care management resources and making them more accessible to members removes complexity from the patient experience and addresses their present-day vulnerabilities. It can be as simple as answering their questions quickly and clearly.

A focus on relationships opens the door for more ambitious endeavors.

"We believe that if plans invest in helping that member meet their needs and achieve their goals while at the same time building a trusting relationship along the way, a by-product of that will be higher value care utilization and ultimately a more competitive plan product," says Sattelmair. "That includes better member satisfaction and retention. Part of our goal is working closely with our partners to instill that ideology and make that investment to cross that gap."

An integrated service model that encompasses billing, benefits, transportation, and education empowers members and paves the way to longitudinal, preventive care where the patient is an active part of the care process.

Thanks to many structural advantages relative to scale, their relationships with providers and employers, and their data and infrastructure, payers have a real opportunity to play a meaningful role in the future of healthcare, a mixture of digital and in-person experiences that lead to improved outcomes and lower costs.

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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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