Silverlink In the News

Managed care is facing a fundamental shift in the way it manages member relations. Historically, payors invested little in developing solid relationships with individuals. This was a logical arrangement, as employers select and paid plans, so plans focused their sales, service, and marketing resources on keeping employers happy.

Recently, consumerism arrived on the scene, and there's little argument that it is having an enormous impact on managed care. Consumer-directed health plans, healthcare spending accounts, and flexible spending accounts, cost shifting from tiered co-pays and tiered provider networks, and Medicare Part D are all working to change the role patients play in healthcare.

In response, managed care is starting to shift its focus from serving the employer to serving the member. While consumer healthcare products and services are multiplying daily, member communications has some catching up to do. For the most part, communications are designed with little or no coordination between functional groups. Service, billing, medical management, pharmacy management, and claims operate in silos and communicate independently. The result of these disparate efforts is consumer confusion, frustration, an inability to manage care, and increasing dissatisfaction with the plan.

Lifecycle-Driven Communications

As patients play an increasing role in managing their own healthcare, they are demanding -- and they deserve -- better access to information. Not necessarily more, but access to the right information at the right time, in digestible increments and in an appealing format.

What does managed care have to do to meet this new consumer expectation? Ultimately, the right solution requires an integrated approach to communications that centers on the life events of the consumer instead of the daily operations of the plan. This approach is called "lifecycle-driven communications."

Here's an example. Let's say a plan learns, through its integration with the provider's electronic medical record system, that a member has just been diagnosed with diabetes.  Within a couple of days, the plan sends the following automated outbound call to the member:

"Our records show that Doctor Jones recently diagnosed you with type 2 diabetes. The American Diabetes Association says that early intervention is the best way to control this disease. That is why USACare has three programs designed to help you manage your treatment. At the end of this call, you'll have an opportunity to hear more information about these programs to determine whether they are right for you. Also, since your out-of-pocket spending may increase based on your diagnosis, you may want to consider increasing your health savings account contribution to pay these costs with 'pretax' dollars. At the end of this call, you'll have an opportunity to speak to a representative about adjusting your contribution. At this time, we'd like to get some information from you about additional insurance coverage you may have..."

In one "touch" of the member, the plan has made an offer of disease management services based on a gold-standard, third-party reference, given a recommendation to increase healthcare spending account allotment, and accomplished coordination of benefits data collection. Consider that this unified approach replaces what traditionally would be four separate letters. Such efficiency brings cost savings and increased revenue to the plan and an increase in satisfaction and trust to the member. This holistic approach will arguably result in better clinical outcomes, which benefits all parties.

Dramatic CRM overhauls can't occur over night. However, there are steps health plans can take today to move their organizations in the right direction:

1. Create a "Communications Map" for your organization
2. Move toward combination programs
3. Integrate communication at the business unit or departmental level
4. Select an individual to serve as a repository of member contact across an organization
5. Implement new technologies that will help get you there faster

While healthcare has historically been slow to adopt new technologies, a successful CRM implementation will require it. Automated voice services are one solution. These services enable managed-care companies to design, deploy, and manage HIPAA-compliant automated calls to members to drive behavior, educate, or collect information.

To close the trust gap among health plans, consumers, and providers, the communication model needs to move to lifecycle-driven communications -- a shift in the way plans relate to members. While a considerable transformation, managed-care leaders who engage in such practices will win consumers' trust and loyalty.

Stan Nowak is a founder and CEO of Silverlink Communications.

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