As consumers, we have come to expect better service than ever before, easy access to the information we need on any platform we want, and clarity around what we’re receiving — and why would that change when it comes to healthcare?
It doesn’t. That’s why so many people are so dissatisfied with the healthcare system as it stands. The patient’s expectations are dramatically different than they used to be, and everyone from providers to employers to insurers and hospital networks is taking notice.
As we’ve learned through our partnerships with payers, insurers and networks are particularly sensitive to these changes and are working hard to better serve their members. To that end, here are our five top posts of the year for insurers.
For insurers, member experience is an essential element in engagement and retention, but it can prove frustrating and difficult to move the needle as many patients struggle with our innately fragmented sick-care system.
Insurers want to know that the solutions they offer set them apart. But what is the best alternative in a system that doesn’t adequately serve the needs of either patients or companies that are invested in their members? Advanced primary care (APC) is a healthcare model that emphasizes a higher quality of care and patient engagement over sheer volume to deliver lower costs and better outcomes.
APC is designed to improve how healthcare is managed by optimizing the connections between patients, primary care, specialists, and clinics. Data analysis, health coaching, integrated behavioral health care, and comprehensive care coordination ensure that patients receive a greater breadth of service than most standard healthcare plans can deliver.
When it comes to patient experience, healthcare is often marked by confusion and fragmentation. Maybe the patient’s primary care provider referred them to a specialist in a different part of town, and they aren’t sure if it’s in-network. Or they want to explore their options for managing anxiety but are nervous about talking to a mental health professional for the first time.
In those situations and a myriad of others, simplifying the system with a single point of care would make all the difference. Instead of referring patients back and forth between primary care and specialists, they receive nearly all of their care through their primary care provider, with a team they trust to guide them and coordinate their care along the way.
For insurers, this translates into not only better member experiences, but also more effective visits, better health outcomes, and fewer unnecessary claims.
For many in our field, population health features heavily in the future of healthcare. How can we build a healthcare system that better serves each patient by looking at the group as a whole? How can the needs and behaviors of each population help us customize care for the group and everyone in it?
Advanced primary care incorporates tools like informatics, care coordination, and health coaching to manage and coordinate services that are tailored to the patient populations who need them. By analyzing historical claims data, we’re able to uncover the areas where we can have the most significant impact and design care teams and care centers around them.
However, this infrastructure is only one factor in how APC works; the more critical element is the relationships it creates. Patients receive their care from a team they trust, and if specialist treatment is required, their primary care team will help them schedule appointments, follow up afterward, and incorporate any changes or medications into their care plans. For patients, this means a dramatically simplified experience that is defined by supportive relationships rather than anxiety and confusion.
As healthcare industry professionals, we’ve all met patients who avoid health screenings or routine checkups because they don’t want to know if anything is wrong. It’s unfortunate, not only because checkups are the best way to catch health issues early, but also because they are excellent opportunities to build patient-provider relationships.
Those relationships matter. For providers, getting to know the patient and building trust are the best ways to learn relevant background and context, including stress, diet, relationships, and risk factors.
Through frequent health screenings and the conversations they facilitate, providers can catch and treat illnesses early, when they’re less painful, disruptive, and, of course, expensive. Just as importantly, the provider and care network is able to give the patient better experiences and a stronger relationship with their provider and care team.
In our care centers, we often find that regardless of the reason a patient seeks care, the root of the problem is a social or environmental factor (known collectively as social determinants). Why does this matter to payers? Because for insurers and networks, improperly diagnosed and treated conditions have a significant impact on both member experience and the bottom line.
Dr. Stephen Spann, founding dean of The University of Houston College of Medicine, explains: “A patient may come in to see me because of chronic low back pain. But it's really related to depression and not the intrinsic back pathology. However, I will treat the whole person. I will deal with the depression and the back pain. My commitment will be to get the patient well.”
Healthcare models that can’t account for social determinants — or give providers time to discover them — aren’t able to provide that type of care, and the patient would continue receiving treatment for the symptom rather than the cause. For the patient’s insurer, that likely means more claims, specialist care, and prescriptions that have secondary impacts of their own. On top of that, the patient is still living with untreated depression and any other symptoms it causes.
For payers, member experience is paramount, and differentiation is crucial. In these posts, we discussed a range of ways that insurers and networks can improve care experiences and outcomes for patients while offering something novel: healthcare that works for them, not against them.