Using Member Engagement to Create Personalized Payer Experience

Personalizing member engagement for self-insured employers

Don Antonucci, senior vice president of commercial markets, knew that self-funded employers play a crucial role in California’s healthcare system—and even outside of California.

“Employers, especially large self-funded employers, are a real key ingredient to transforming healthcare in the US,” he told HealthPayerIntelligence. 

In 2017, according to California’s Department of Industrial Relations Office of Self-Insurance Plans, 4.3 million employees in California were on a self-insured plan. That encompasses one in every four workers in the state. Over 7,000 employers are actively self-insured.

Given the nature of self-insurance, self-insured employers require much more flexibility from payers than traditional health plans.

“Self-insured employers are picking different point solutions,” Antonucci explained. “It could be behavioral health, it could be their RX vendor, it could be a transparency tool. And what they need is to be able to have that seamlessly all come together.”

Such a variety of needs can be challenging to serve, Antonucci admitted. Different payers address this challenge in different ways.

“Self-insured employers expect to be able to control costs and quality, but they want to do it their way,” he explained. “They want to make sure that they're pulling together the package that makes sense for them and their population.”

But Antonucci and Blue Shield California also saw those diverse demands as an opportunity.

With these employers and their members in mind, Blue Shield California started looking for a partner that fit into Blue Shield California’s overall mission — “healthcare that's worthy of our family and friends” — and enabled personalization and improved navigation.

Thus, at the end of February 2020, Blue Shield California announced its partnership with Accolade.

The companies are collaborating to support self-funded employers’ member engagement with personalized options, offering a selection of point solutions for employers.

“With this capability we expect that members are going to be able to understand their benefits really clearly. We expect that we're also going to be able to see higher quality, lower costs as a result of this type of a combination for the right large self-funded employers,” Antonucci shared.

Through the platform, self-insured employers’ members will have access to Blue Shield California’s provider network. The collaboration serves members across the continuum of care, from prevention to follow-up.

Together, the companies will work to improve the payer’s self-insured employer health plan benefits by adding a layer of technological advancement and customizability, Antonucci indicated.

The healthcare payer’s partnership has implications for Blue Shield of California-insured employers nationwide. The changes extend to employers whose companies exist in California and also to employers that are headquartered in California with branches in other states.

Importantly, this will not supplant national employers’ BlueCard value-based care network and benefits. Instead, the new technology platform will integrate into these offerings.

Blue Shield named three main results the payer hopes to see from the platform: increased program utilization, better patient satisfaction, and lower healthcare spending through reduced claims costs.

When the new platform launches in January 2021, all of the employees covered by self-insured employers who have partnered with Blue Shield could have access to health assistants and clinicians who can attend not only medical needs but also assist with benefits navigation.

Personalizing Medication Adherence through Predictive Analytics

Meanwhile, to the east in Kansas City, Missouri, another Blue Cross Blue Shield organization is working toward personalization through technology.

At a million members, Blue Cross and Blue Shield of Kansas City (Blue KC) covers nearly half of greater Kansas City’s population.

Medication adherence is a pervasive issue in America, but particularly in states like Missouri. 

For example, for patients with COPD, a study conducted from 2016 to 2017 demonstrated that over a third of the more than 600 patients researched exhibited poor adherence to their medications. While the patients had a high symptom burden, the mean proportion of days covered on which patients took their medications was 46 percent—meaning that for around half of the study’s timeframe patients were generally nonadherent.

Blue KC was making an effort to promote adherence, but its strategy was falling short, Lori Rund, vice president of government programs at Blue KC, informed HealthPayerIntelligence. The payer engaged in clinical outreach programs based on general trends.

“It wasn't looking at their past, current, and historic utilization and really tailoring it to them and then really having that pharmacy outreach, as well as the clinical outreach on that piece of it,” Rund explained. “But by using the predictive analytics, we took that pharmacy and clinical outreach to a brand new level and are pretty excited that it's really going to make a difference in what we're doing and really impact the overall health of our members.”

For most payers, accessing technology to enable a personalized approach is not the issue, according to Rund.

“With the technology, everything is in place,” Rund said. “It’s making sure we have the right information and connecting information that's available with the technology that's there to make it so that it is all in one place.”

Blue KC had used predictive analytics previously to direct their social determinants of health strategy, connecting members to appropriate resources.

As a result, Rund and her team knew what to look for when deciding to partner with a predictive analytics team to offer more personalization to their strategy. They were looking for results.

In its partnership with AdhereHealth, the payer found a tool that combined clinical support and medication dispensation solution. It brings to light socioeconomic factors during providers’ patient engagement through real-time prescribing information but is designed to avoid alert fatigue. Patients can receive their medications by delivery.

Blue KC’s personalized platform is not for a specific community of members, unlike Blue Shield California, which used their personalized tool to create targeted solutions for members under self-insured employers.

Instead, Blue KC’s goal is to make medication adherence more attainable for all of their members, no matter what the obstacle might be — affordability, chronic conditions leading to multiple medications, access to medication, or lack of information.

“By using predictive analytics, you can focus more on the individualized member, really understand current and historic utilization of prescribed medications, and then from there, really tailor the clinical outreach and the clinical education that goes along with that to reach out to the members,” she said. “It really helps to personalize it more.”

As they look to serve different populations through greater personalization, Antonucci and Rund agree that employing effective, proven technologies is key.

“We've got to have a system and solutions that are high-tech and high-touch with this personalized approach,” said Antonucci. 

“We want to move that needle as far and as fast as possible in a way that's really going to benefit employers, their employees, their families, and change that experience. The real power is lining all that up with that employer's benefits strategy, what they're trying to do for their population, and then making sure that we're seeing real results around quality costs and experience.”