How Integrated Communication Platforms Can Drive Value for Payers

The vast majority of US health insurers have made investments in digital technologies to create business efficiencies, but many of these digital investments have not yet “translated” into better financial performance and new business growth. A recent Accenture research study revealed that solely focusing on business efficiencies may lead to achieving ”short-lived gains” but longer-term value will result from using digital technologies to transform the health care industry. However, the use of integrated communication platforms can help drive short- and long-term value, helping payers achieve their goals of increasing member engagement, optimizing resources, and improving outcomes.

How can integrated communication platforms help payers deliver care that is more efficient and more effective? The key is “virtual.”  Virtual care is critical to bringing timely and quality care to a plan’s members while bringing value to the payer’s bottom line. In the case of members with chronic condition(s), an integrated communication platform can be vital in engaging these members in better understanding and managing their conditions on a continued basis, from the convenience of their home. The implications are significant in terms of the care enhancements, cost savings, program efficiencies, and overall effectiveness for members and payers.

Increasing Member Engagement
An integrated communication platform helps payers provide members with more ways to access convenient and timely follow-up care, from wherever they are located. Virtual care technology leverages member preferences by allowing members to engage with follow-up care providers via their preferred device (e.g., a tablet, smartphone, or laptop), from their preferred location (e.g., home), and at their preferred time (e.g., when it works best for their daily routine; when they have an urgent question or issue). A variety of convenient options for follow-up care helps strengthen member engagement since members will not need to worry about securing reliable and/or affordable transportation to and from appointments.

To fully engage members, health plans must go beyond thinking of each member interaction as an isolated touchpoint, and as something that must be conducted in-person (e.g., at a home visit or doctor’s office) or over the phone. By offering members the ability to receive communications and reminders about upcoming virtual visits via email, secure messaging, and/or other modalities, payers can reach out to members according to individual preferences. With each member’s condition(s) and treatment plan in mind, payers can then plan the scheduling and messaging (e.g., key questions to ask, key points to communicate) for each touchpoint — whether the touchpoint is an email, a text message, or the actual virtual visit. Each touchpoint reinforces the treatment plan and encourages members to continue self-care as much as possible.

Optimizing Resources
The advantages of using an integrated communication platform includes better staffing efficiencies and enhanced productivity. The nature of a virtual, video-based visit will help the providers “see” the member in his/her home environment and personal lifestyle in order to better tailor each conversation to the reality of the member’s current situation, and how care can be best managed at home. With each subsequent virtual visit, providers can better monitor and motivate members on a more regular basis and leverage the interactions to reinforce condition education and medication adherence, while being on the lookout for emerging situations before drastic intervention is needed. Increasing the frequency of follow-up appointments means that providers can address potentially serious conditions and minimize the need for hospitalization or emergency care services. As providers have the ability to detect members’ potential issues before an in-person consult is needed, more preventative measures can be utilized earlier in the process, and unnecessary ER visits and hospital readmissions can be minimized. Early and ongoing detection can help address the progress of a condition – especially before the condition worsens and becomes more difficult and more expensive to treat. The care is more efficient, more timely, and more individualized to the member’s situation at each point in time.

To best optimize available provider resources, payers should consider using virtual care to enhance their current workflows. Staff can leverage an integrated communication platform to follow up with members, minimizing travel costs (and time) spent driving to/from member homes for in-person appointments while increasing the ability to provide care to more members. Staff can also be scheduled to best match members’ preferred timing for virtual visits. Staff can be augmented to address the shortfall of providers due to geographical or scheduling constraints.

Improving Outcomes
By using an integrated communication platform, health plans can drive better performance for their members’ physical and mental health, as well as their organization’s financial health. The overall health care system — including payers and providers — is also positively impacted by the introduction and use of virtual care technology. All stakeholders benefit from improved outcomes and a decrease in penalties typically associated with member readmissions. Payers and providers can use a video-based communication platform to expand the accessibility and availability of care beyond the four walls of traditional health care settings.

As a case in point, when the Veterans Health Administration (VHA) introduced the national home-based virtual care program, Care Coordination/Home Telehealth, it sought to avoid the unnecessary admission of veteran patients with chronic conditions to long-term institutional care. With the new program, VHA showed multiple related benefits — including a 25% reduction in number of bed days of care, 19% reduction in number of hospital admissions, and a mean satisfaction score rating of 86% after enrollment into the program — resulting in an increase in member satisfaction and loyalty. In this way, a health plan that helps a member stay at home can translate into a member staying with the health plan going forward. The efficiencies and effectiveness from an integrated communication platform can cut costs for payers while improving care and outcomes for all.

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