The Covid-19 pandemic has altered all aspects of life – most acutely impacting the healthcare industry and bringing to light major deficiencies in how care is delivered. Many healthcare providers have experienced significant losses due to the pandemic causing the cancellation of elective procedures and missed medical appointments – with some payors losing upwards of hundreds of millions of dollars. Changes to the annual open enrollment period have also increased acquisition costs, which is a positive for members, as the rise has driven health plans to place a stronger focus on areas that influence retention, such as member experience.
With a rapidly changing landscape, payors and providers must prioritize the consumerization of healthcare more than ever before and implement “surprise and delight” programs that meet critical needs and enhance customer satisfaction to ensure positive ratings and retention. In the future, more and more lines of business will be held to higher quality and experience standards, and health plans must ask themselves hard questions like, “how can we get closer to members in a cost-effective way? How can we build trust with our members?”
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Moshe Pinto Moshe is the co-founder and CEO of Wider Circle, an innovative community care program working with health plans nationally to connect members with familiar neighbors to inform, support and motivate the most vulnerable populations. Whether face to face, over the phone or via online communications, Wider Circle is building trusted relationships in more […]
Now, health plans must identify ways to authentically connect with their members and fulfill their needs holistically to drive better health outcomes. Below are three ways that healthcare can improve member experience and chronic disease management:
Expand Social Determinants of Health (SDOH) Programs
The virus and the resulting economic ramifications of Covid-19 restrictions have exposed the urgency to expand SDOH programs. There is a particularly acute need for programs that address food insecurity, medication access and telehealth implementation. Health plans must embrace the benefits of expanding these programs from a commercial perspective, as they are vital tools to manage chronic disease. This will require a greater emphasis on community engagement, which includes the “last mile” of healthcare, to make these programs more widely available and increase home deliveries to address channel disintermediation. An example of one such program is the recent partnership between Optum and Wider Circle, which, as part of its response to the pandemic, has delivered more than 82 tons of food to food-insecure individuals and families in California.
Focus on Behavioral Health Needs
The pandemic has exacerbated the existing mental health crisis in America, highlighting the need to reassess our approach to behavioral health assessment and management. Many calls to health plans are from people who are depressed or anxious, and benefits navigation can be a significant challenge for individuals seeking support for mental illness issues.
Clearly, there is a lack of access to behavioral health networks, and Covid-19 has shown the need for a better understanding of how mental health affects a person’s overall wellness and for greater availability of screening. Despite the increase in behavioral health needs, many Medicare beneficiaries do not know help is possible, do not trust the system or are daunted by its bureaucracy. Often, they cannot find culturally competent counseling, do not know where to go or their traditions demand they tough it out.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
In response, there must be a push to create tools, such as support groups that are less clinically intense but more accessible for members, and the community has to be part of the solution to those challenges.
Get Remote Engagement Right
Telehealth is the biggest winner in the last year, as there has been much broader adoption of apps and tools for patients to navigate and consume healthcare remotely. Health plans had to accelerate innovation and embrace technologies that enabled them to manage workforces and patients, which has led to the implementation of tools at a pace heretofore unseen in the industry.
However, there is still a big issue when it comes to reaching Medicare Advantage populations. Virtual care deepens the already problematic digital divide, as these individuals do not have the necessary technology for these visits. To combat this issue, more and more health plans are hand-delivering tablets to members and taking the time to properly educate seniors on how to use the technology and feel comfortable with it.
While the pandemic has challenged us all and caused great hardship, it has also imparted important lessons that the industry can learn from to change healthcare for the better. Whether it is conquering the last mile in healthcare, meeting the country’s mental health crisis head-on or leveraging digital health tools effectively, trust will be central to the future of the member experience. Covid-19 has widened the very large trust gap that exists between individuals in the community and the care they are receiving, and as such, healthcare must focus on rebuilding confidence between patients and the healthcare system to improve satisfaction. The impact of Covid-19 will be felt by the industry for many years to come – hopefully to a positive effect for everyone in the healthcare value chain.
Photo: turk_stock_photographer, Getty Images
Moshe is the co-founder and CEO of Wider Circle, an innovative community care program working with health plans nationally to connect members with familiar neighbors to inform, support and motivate the most vulnerable populations. Whether face to face, over the phone or via online communications, Wider Circle is building trusted relationships in more than 135 communities across the country to inform and support individuals on their path toward improved health.
Prior to Wider Circle, Moshe founded Spiracur Inc., a company focused on advanced wound care systems. During that time, he led the organization through a $65M investment round and spearheaded product commercialization efforts. Additional healthcare experience includes leading HD+ (now Outset Medical), a company focused on the development of technologies to address the needs of patients with kidney failure.
