It’s time for health plans, providers, and digital health companies to recognize that traditional member engagement is failing patients and members.
CMS is clearly pushing our industry to rethink how we approach the member engagement space. By shifting the criteria in its quality ratings to emphasize treatment plan adherence and other member behaviors that have traditionally been beyond plans’ direct influence, CMS is telling plans that they need to take a greater role in changing member behavior – in addition to everything they already do.
Price Transparency is the New North in the PBM World
In this episode hear how improving benefit verification, prior authorizations, and patient affordability with smart integrations and real-time eligibility can streamline healthcare workflows.
As health plans scramble to adapt today, they’re learning that our industry has set the bar for member engagement far too low.
In every other industry, from social media to gaming to streaming, engagement is well understood and optimized. Companies like Netflix and Meta track daily active users, monthly active users, hours streamed, content clicked, and more to increase member engagement and deliver a personalized user experience that keeps people coming back for more.
In contrast, the status quo of member engagement in healthcare looks like an automated email, a phone call from a care manager, or a template mailer. Member engagement solutions market their ability to convince a member to schedule an overdue appointment or refill a prescription. While these actions matter, they’re a far cry from the success metrics adopted by engagement technologies in other industries.
We have to stop accepting the status quo in healthcare if we want to drive the results our industry needs to help members stay adherent to their care plans and keep health plans operational.
Simplify Salon & Spa Employee Management with Meevo’s Comprehensive Software
Meevo offers an all-in-one solution for managing salon and spa employees. From scheduling and time tracking to payroll and promotions, Meevo streamlines operations and supports growth.
Leveling up from status quo ‘member engagement’ to ‘daily care motivation’
Most member engagement approaches in our industry have evolved to fit a familiar pattern, typically consisting of a one-way communication that allows a plan to check a box showing they tried. For members who are already overwhelmed by chronic conditions and life stressors, these communications rarely elicit a response, let alone motivate daily action.
This is why traditional member engagement solutions struggle to produce results for the hard-to-reach 30-40% of health plans’ members whose non-adherent behaviors will make or break a plan’s quality ratings and operating margins.
The results for most first-generation digital health or wellness apps showcase the dilemma. While these tools show relatively strong adherence and retention for the first two months of use, the data shows that they drop below 50% by the end of the second month. By month twelve, retention for digital health apps is a meager 18%, with wellness apps at just 16%. While many of these apps have improved the user experience and offer greater accessibility, they have yet to ‘crack the code’ for creating meaningful and consistent motivation among users.
So what’s the answer? In short, it’s to apply lessons from other industries to help plan members build and internalize beneficial behaviors – and to reward those behaviors in meaningful ways. We call this model ‘daily care motivation.’
What healthcare can learn from video games and streamers
On first glance, video games may not seem relevant to achieving better outcomes in healthcare. However, as gaming has become more mainstream, game developers and publishers have gained powerful insights into human behavior and motivation that our industry would do well to adopt.
The most immersive games, for example, keep players engaged by replicating the sense of accomplishment we feel from achieving real-life goals within their game worlds. As players accumulate experience or complete challenging tasks, they take satisfaction in seeing their in-game characters quickly ‘level up.’
These same behavioral science principles hold the key to reimagining member engagement in our industry. In order to truly motivate tough-to-reach patients, health plans should consider incentive programs that help members feel a sense of consistent progression in their own lives, with rewards that actually make a difference.
When members realize that adhering to their treatment plans can help them more easily afford groceries, for example, or pay for transportation costs, that’s when their treatment plans, daily check-ins and other healthy behaviors become internalized and truly important to them. In marketing speak, that’s when member engagement becomes ‘sticky.’
There are key lessons to learn from streamers like Netflix, as well. The features for health plans and digital health companies to emulate here are obvious: Personalization and eliminating friction. The same way we respond to customized recommendations and user-friendly design by binging multiple episodes, plan members respond to personalized, easy-to-use interfaces.
The benefits of a behavioral science-driven approach don’t stop there. Hard-to-reach members begin to feel a strong sense of accomplishment and well-being as they accumulate consecutive days of check-ins and treatment plan adherence. As they extend their personal ‘win streaks’ and see their lives improving day-by-day, they build their own self-reinforcing flywheels of healthy daily behaviors.
Conclusion
As CMS’ recent changes to its Star Ratings criteria and other guidance makes clear, legacy approaches to member engagement and first-generation digital health apps have not succeeded in driving sustainable change and better outcomes for tough-to-reach patient populations.
It’s time to hold ourselves to a higher standard. Our industry needs to reimagine what can be accomplished in member engagement by more effectively incorporating behavioral science principles and personalization into our solutions, just as leaders in other industries have done.
By pivoting our approach from ‘member engagement’ to meaningful daily care motivation, we can stop telling individuals what they should do and instead motivate them daily with rewarding experiences that improve their health, lower costs, and drive quality outcomes.
Photo: elenabs, Getty Images
Matt Loper is the Co-Founder and CEO of Wellth, a science-backed and award-winning behavioral change company that helps people create sustainable healthy habits. He oversees strategy, sales, business development, and finance for Wellth.
Matt is inspired by the chance to create scalable positive behavior change in patients with chronic conditions and humbled by the fact that Wellth gets to work with some of the best healthcare providers and insurers in the industry.
Prior to founding Wellth, Matt was an investor in publicly traded healthcare technology, medical devices, and services companies at OrbiMed Advisors, a leading healthcare investment firm with $13 billion under management. He also worked in Healthcare Investment Banking at Goldman Sachs.
Matt holds a BS in Biological Engineering from MIT. He is a lifelong fan of the Los Angeles Lakers and played college baseball. He enjoys spending time with his Australian Shepherd, Luna.
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.