The forces driving health plan member experience improvement

Published 04-28-2021 07:43 AM 561 Views
Microsoft

Claire Bonaci 

You're watching the Microsoft us health and life sciences, confessions of health geeks podcast, a show the offers Industry Insight from the health geeks and data freaks of the US health and life sciences industry team. I'm your host, Claire Bonaci. On episode two of the three part patient experience series guest host, Antoinette Thomas discusses health plan member experience with our Director of population health, Amy Burke.

 

Toni Thomas 

Amy, thank you for joining. As we get started, it would be great to share a little bit about yourself with our guests.

 

Amy Berk 

Wonderful, thank you so much for having me, Toni. So I am the new director of Population Health at Microsoft, I bring forth clinical and operational experience in the population health realm or ecosystem, I started my career as a nurse. So I am a clinican by background. And after graduate school, I embarked on a career in consulting, I'd been a healthcare consultant for 15 years. And the span of my work is cross payers and providers, looking at innovation of care delivery models, working domestically and internationally, working in the public and private sectors. So I feel that my experience is broad, but also very focused on population health.

 

Toni Thomas 

So I'm really glad to be working with you. And as the person that's really responsible for developing the point of view on experience for health and life sciences, I think it's really important to, you know, work with all my colleagues on the industry, industry team across their subject matter to make sure we're developing a holistic view of experience. And so if you would, um, can you share a little bit about traditional member experience? And what drives improvement of that experience inside health plan or per the purview of health plan? And the second part of that question is, does consumerism play a role?

 

Amy Berk 

So thank you so much for that question. Toni, I've had some time to think about that question. And, in my mind, the traditional role of the member in a health plan is one that was very reactive versus proactive. We have care managers that are reaching out to engage our members in these programs. Oftentimes, members aren't even aware of these programs. So how can the health plan really be more keen on outreach and targeting members for these type of programs, health care management, behavioral health programs, pharmacy programs, etc. You know, and even in the role, or probably even in the traditional realm of care management, it has been very much a telephonic model, and how much how much impact we have over the telephone versus how can we engage our members through digital mechanisms, digital modalities, pardon me, like virtual, like digital, etc. So really, you know, harnessing in on engaging that member more through more creative technologies, and I would say also, that it empowers the member, then to really have a responsibility to, you know, take care of themselves, right We are, we are putting the member in, in a place of power to really be able to, you know, engage to be proactive with their own healthcare. And I forgot to mention, but this is an important part as well, in terms of, you know, what's out there in terms of remote patient monitoring. So, you know, really putting the onus on them to take care of their health in a way that they haven't done before, and that, that spans across the entire continuum of health. And I would say even the, the entire continuum of demographics, through age and culture and gender, etc. So I think it's really a good place for any consumer to be right now. Because consumers today have choices like they hadn't had before. You can go on the internet and consumers can look up and, and really have a clear picture and understanding and knowledge of their disease course of their condition. They have, you know, knowledge of who their providers are against other providers, they can now look up price transparency, is becoming very prominent in terms of being able to look up costs. So that's very important to consumers today. And I think that, you know, putting our consumers at the heart of what we do, both from a chronic care management perspective, as well as a member satisfaction perspective becomes quite important.

 

Toni Thomas 

So in the hospital world, and the clinic world, we have, you know, the H caps measurements that measure how satisfied a patient might be with within certain realms of that experience. How, how do health plans, how do health plans solicit feedback from their members to understand how satisfied they are with the experience that they're having within their care management program are within the health plan itself.

 

Amy Berk 

So there are a couple of ways in which that happens. So there are h caps that applied to the member experience and a health plan also stars. So that's a CMS quality measure for Medicare programs, member satisfaction is actually now weighted most heavily in those star measures. And thirdly, then, you know, through surveys that are solicited to members, through their net promoter scores, etc, that become quite relevant in terms of measuring member satisfaction.

 

Toni Thomas 

That's great, because I know some of the the listening audience might be Microsoft health and life science field sales teams who are really trying to understand a little bit more about how satisfaction is rated. So that's helpful to them in their daily jobs, like certainly to understand specifically the star ratings that you referenced. Something that I'm personally interested in, and I think our audience would be interested in is the comparison or contrast between what healthcare system patient experiences and I think most people understand that, and health plan member experience, so if you could, you know, give a little bit of that picture of what that looks like, that'd be helpful.

 

Amy Berk 

so I would say that, you know, a patient versus a member, if we want to put it in that perspective, a patient is often going to the hospital, for reasons in which they need to be taken care of. And they become a guest at that hospital in that, you know, they're, they're being taken care of by nurses, and there are physicians there that are treating them with protocols, etc. You know, and often this is in a place of sickness versus in health, right, so a patient is sick. And, you know, that in itself brings in a cadre of, of emotions and experiences of that patient in the hospital, right, where once that patient goes out of the hospital is discharged from the hospital, rather, their disposition to a post acute facility or to home. And they're within an environment that, you know, they're now on the road to recovery, and they're well, and, you know, they're getting healthy or healthier, shall I say. And it goes back to that first comment, which I said, where the member has more, I would say, power, more, you know, ability to manage their condition, right. And this of work becomes so important for our care managers that are out there to take a proactive approach with our members to engage them better in their care. So they can have that opportunity to self manage their care for better outcomes. So you know, now it's more proactive, and I would say where I said, The patient is a guest of the hospital and that everything is directed by this interdisciplinary care team in, you know, how they deliver care. Now, it becomes a little bit different of a shift to now the care management team, the interdisciplinary team is a is a guest to that member's home, even when the person or the member goes to see the provider. There's it's still a different dynamic, right? Because I think that that member is at the heart in the center of making key decisions and shared decision making. And that applies to to the provider side, right, there should be shared decision making in the hospital setting as well. But I think it's even more elevated in the post acute setting in that members are on their way to becoming healthy. And a member has control over that pathway, more so than a patient, if that makes sense.

 

Toni Thomas 

I think that's really profound. And it's it's also very interesting, Amy because some of the things I've been doing a lot of reading and research on agency and like a personal agency. And I think what we're seeing right now with patients, consumers, customers members is that They're exhibiting more personal agency than they ever have before. People who study this aren't really certain as to why that might be. I don't think there's one reason for it, I think there's a multitude of reasons I'm having access to information technology. And also the fact that we have been living 12 months inside of a pandemic, where they really feel that they have to take control over their own health, their own wellness, their own decision making. And so what I'm starting to see in the provider or the healthcare systems, space is really kind of this movement that you were referencing about. Being a collaborator with someone in their health, health, knowing that person personally, to offer the guidance that they need to make the decisions about their health. So I'm really starting to see healthcare systems want to move in that direction, especially on how they're communicating with patients, either who are trying to make appointments, or soliciting some advice on hospitals. And it's just really interesting paradigm shift. So I'm excited to see what happens there. I think it's important. And then lastly, what important lessons can the healthcare system world and the plan world learn from one another to improve this experience?

 

Amy Berk 

Yeah, so thank you for that question. And this, again, centers around, we have to focus in on patient member centric care, and what that means and including the member in terms of or the patient, what matters most to them. In terms of their care journey, I would also say that, you know, we have to think about our patients slash members holistically. So we shouldn't be focusing in on one disease we should be focusing in on if that person has co morbidities if that person has gaps in terms of social determinants of health, behavioral health, post pandemic, I mean, the, the crisis of mental health, as it has never been before is is a pandemic in itself, right. So, you know, really honing in on not just one disease or one condition or even that person's clinical picture, but we have to think more broadly, in terms of that person holistically, right, and bring through those social determinants that have impact on their health outcomes, behavioral health, emotions, and, you know, and needs. So I would, I would say, that's very important, and that spans across both provider and member and, you know, holistically, culturally, clinically, etc.

 

Toni Thomas 

So that brings us to the end of our time together. But I do want to say I always enjoy speaking with you and asking you questions because I, I learn so much from you, Amy and I, I've learned things that will help me make me better in my job and also allow me to help the customers that I'm out there serving. So I really, really thank you for joining us for this session and contributing to patient experience. We thank you so much.

 

Claire Bonaci 

Thank you all for watching. Please feel free to leave us questions or comments below and check back soon for more content from the HLS industry team.

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