Using Digital Health Management Platforms to Connect With Members, Improve Care

Sandhya Gardner, MD, chief medical officer at Wellframe, shares insight from a recent survey about plan member engagement, discusses care management and coordination via digital health tools, and explains how the pandemic has shed light on common barriers to care.

Please tell us about your background in health care.

I’ve always been passionate about helping people get access to the health support and care that they need to feel their best. I first entered the field as a practicing obstetrician-gynecologist and came to appreciate the holistic nature of health care—recognizing the importance of supporting patients through their whole health journey while arming them with the knowledge and tools to improve their health. After more than a decade of clinical practice, I shifted my focus to overseeing the strategy and development of educational programs and performance improvement solutions designed to optimize health care outcomes at greater scale. A key area of focus of this work has been to develop solutions that identify and address the unintended variations in care and outcomes that we see throughout health care, and the current pandemic is undoubtedly the most recent and painful reminder of this issue.

Now, as chief medical officer at Wellframe, my team is dedicated to ensuring that people get the long-term, convenient, and personalized health education they need to become informed and empowered self-advocates for their care and well-being

Can you talk about Wellframe’s recent survey? What prompted you to conduct this survey?

We conducted our 2020 Health Plan Member Engagement Survey in October to help our health plan customers understand the needs of their members during an especially tumultuous and stressful time. We wanted to better understand what members’ expectations were regarding their health insurance benefits and sought to identify gaps across their health care experience.

These findings built upon our COVID-19 Chronic Condition Patient Population Report, which we published in May to offer insight into how vulnerable populations were navigating their health needs amidst the challenging constraints catalyzed by the pandemic.

What were some of the major findings of the survey? Were you surprised by what was found?

One of the key takeaways from the survey is that members aren’t getting the continuous and convenient health support they expect, nor do they feel that what they are receiving reflects their unique individual needs. For instance, 60% of those surveyed said they think much of the information they receive from the health care system is “too generic and not personalized to me.” Additionally, 57% of respondents have sought support or guidance from their health plan and have been “frustrated” by the experience. Another 46% said they wish there was more support from doctors and health plans for their personal health care journey.

While not necessarily surprising, these findings do suggest that there are significant opportunities to improve the guidance people receive beyond the four walls of care delivery. There was also a broad sentiment that people want to receive care management and coordination from their health plans, especially as patients are increasingly receptive to virtual health options—72% said they would use a virtual care management team to help them manage a health condition.

Based on the survey findings, can you talk about how and why health plans want to assist with care management and coordination? How will this improve patient care and outcomes?

Care management predominantly resides with health plans, as these organizations have both the ability and desire to adopt technologies and strategies that can effectively identify, engage, and understand the needs of individuals. Importantly, health plans also have the financial wherewithal to be able to integrate these digital solutions.

Ultimately, health plans are incredibly well positioned to deliver a seamless and coordinated experience because they have unparalleled insight into crucial information across a member’s network of providers, treatments, claims, and benefits—information that creates a more complete picture of the member’s health needs. When health plans use the right technology to both harness this information and reach and engage members, plan staff can respond with timely, personalized support that improves both the experience and outcomes of their populations.

What has COVID brought to light in terms of needing more holistic care management and triage to support patients beyond just their appointment(s), and assist with social determinants of health, which impact mental health, access to care/pharma, and costs?

The COVID-19 pandemic has undoubtedly exacerbated social barriers to health such as financial instability, employment status, concerns about food availability, housing, and health care access. But health care organizations cannot address these factors if they are not able to uncover their existence in the first place.

While telehealth holds promise to improve health care access, it is still episodic in nature. As data shows, ~80% of health outcomes are determined by factors outside of clinical care—including health behaviors, social and economic factors, and physical environment. Whether visits are virtual or in-person, we know providers cannot always identify and address those numerous nonclinical factors that can contribute to adverse health outcomes.

Many health plans today are able to identify the ebb and flow of SDoH by establishing longitudinal and trusting relationships with their members through a digital channel. In fact, at the onset of the pandemic, we observed a 10 times increase in member messages about coronavirus-related SDoH barriers such as lack of childcare, unemployment, and loneliness on the Wellframe platform. Health plans can then use that same digital channel to direct members to the appropriate resources, whether it’s transportation assistance to pick up prescriptions or help understanding costs and coverage.

In order to help improve and address the future successes of our health systems, do you have tips for health insurers to evolve so that they can most effectively participate in the care continuum?

Consumers have been conditioned to expect convenient, Amazon-like experiences across their day-to-day lives, with mobile devices at the center of how they digest information. As our survey findings reinforce, consumers have come to expect that same seamless experience from health care as well. Health insurance plans are ideally positioned to deliver the integrated digital experience that spans the entire health care journey of these members.

Embracing a digital health management strategy that provides members with more unified and coordinated experiences can help plans connect the dots between in-person and virtual care. There is no reliable way to predict when members may seek medical support or information, so providing them with a channel that they can access on their own time becomes paramount. Additionally, offering a technology solution that members can access right from their smartphone means that they will have the tools they need to improve their health in the palm of their hand.

How and why are health plans ideally situated to lead the charge with care management and care coordination?

Health plans have unique insight into members’ data and health journeys, which means they can help provide a more tailored, streamlined experience that can ultimately lead to better health outcomes. In addition to providing advice on how to manage specific conditions, they can offer valuable health care navigation information about benefits, costs, and other nonclinical topics, which members are often confused about. According to our survey, 51% of those surveyed said they find it difficult to understand health care costs, such as the cost of prescriptions or out-of-pocket care costs. In a separate question, 24% said they received a health care bill or explanation of benefits they didn’t understand, and 20% said they were unsure if they had met a deductible.

Poor health literacy can certainly contribute to adverse health outcomes. For example, as a result of their misunderstanding or inconsistent communication with their providers, 42% of health plan members forgot to take a dose of their prescription, 34% missed one or more appointments, and 13.5% had difficulty monitoring a health biometric, such as blood pressure or blood sugar. Health plans can fill the gaps in care by connecting members to educational resources and teams who can answer their questions whenever and wherever they arise through convenient digital channels.

Is there anything else you would like to add?

Now is the time for health plans to take stock, reevaluate those strategies that are not meeting the needs of members, and explore new solutions to improve member experience and outcomes. Specifically, plans should strongly consider digital health management platforms that enable them to efficiently connect members with the support and care coordination they have come to expect. Plans can capitalize on their insight and access to member information to target members with the specific information required to improve their health. The demand for virtual health support is here to stay, and there has never been a better opportunity for plans to step in and provide the digital guidance and assistance that they’re well positioned to offer.