At the HealthEdge Leadership Forum in October, health plan leaders shared their insights about adopting digital member experience solutions to improve engagement and operational efficiencies. Michelle Fullerton, Vice President of Care Management at Blue Cross Blue Shield of Michigan (BCBS of Michigan), and Dr. Josette Gordon-Simet, Chief Medical Officer at Blue Cross Blue Shield of Nebraska (BCBS of Nebraska), joined a conversation with HealthEdge’s Chief Medical Officer, Sandhya Gardner, MD, on how these two prominent health plans transformed care management.
Let’s review the key takeaways from this discussion on how digital member experience led to significant improvements in member interactions and improved the efficiency of care management.
Key Takeaways: Adopting Digital Member Experience
1. Digital Engagement Solutions Improve Member Experience
Both BCBS of Michigan and BCBS of Nebraska recognized that traditional telephonic-centric processes alone no longer met members’ expectations for convenience and personalization. With the rise of digital consumer experiences, members increasingly expected similar access and immediacy in healthcare.
BCBS of Michigan began its care management transformation by adopting the Wellframe™ member experience platform. This shift allowed for automated outreach and real-time communication with members, replacing labor-intensive phone calls as the primary method of engagement. The result was a sharp increase in interactions that enabled earlier interventions and better health outcomes.
“We needed another way… We went all-in with digital care management, and the engagement numbers speak for themselves. We’ve gone from four or five interventions per case to 20-40… and we’re answering questions in real-time.” – Michelle Fullerton
Similarly, BCBS of Nebraska adopted Wellframe to address the limitations of traditional outreach. Wellframe’s app allowed members to chat directly with care managers and access digital health resources when convenient.
With Wellframe, BCBS of Nebraska also implemented a model for continuity of care. When one care manager is out of the office, interactions can be effortlessly assigned to other staff who have easy access to all the patient data needed to take the next step.
“Our ‘One Nurse, One Source, One Connection’ model ensures continuity, and Wellframe allows us to provide a seamless experience for our members.” – Dr. Josette Gordon-Simet
With a digital member experience, these health plans report that members are better supported and connected to their care teams, which leads to better engagement and interventions across the board.
2. Digital Tools Save Time and Improve Focus for Care Teams
Adopting Wellframe’s digital tools has significantly lightened the cognitive load on care teams. Streamlined workflows allow care managers to practice at the top of their licenses. Two examples highlighted are the introduction of digital assessments and a new solution, Wellframe’s AI Summarizer, of which BCBS of Nebraska was an early adopter.
BCBS of Michigan rolled out digital assessments, allowing members to submit their health information online. This shift from phone-based assessments to a digital workflow has freed up time for care teams to focus on critical interventions and member engagement.
“We integrated digital assessments into our system… nurses love it, and members like the convenience of answering digitally.” – Michelle Fullerton
For BCBS of Nebraska, Wellframe’s new AI Summarizer significantly reduced care managers’ time preparing for patient interactions. By generating concise summaries of previous engagements, the solution allows managers to quickly understand a member’s history without reviewing extensive notes or asking patients to repeat themselves.
“The AI Summarizer has been fantastic for our nurses, cutting down on time spent reviewing previous notes and letting them focus on care delivery.” – Dr. Josette Gordon-Simet
These streamlined workflows demonstrate how care teams can dedicate more time to direct member care rather than being bogged down by administrative tasks.
3. Seamless Care Management Requires Systems Integration
For BCBS of Michigan and BCBS Nebraska, integrating Wellframe into their other systems was key to their digital strategy. These integrations ensure that data—such as member assessments, alerts, and real-time updates—automatically feeds into the broader documentation and workflows care teams use, allowing for more efficient and timely care planning.
Before implementing Wellframe, care teams at BCBS of Michigan and BCBS of Nebraska often had to manually input or track down critical member information across multiple systems, leading to inefficiencies and care coordination delays. With Wellframe, all relevant member data, including health assessments and real-time alerts, is directly integrated into the existing infrastructure.
This data centralization gives care teams a comprehensive view of the member’s health journey, allowing them to make more informed decisions and act quickly.
“We integrated Wellframe into our care management system, and now nurses get real-time alerts and automatically documented updates.” – Michelle Fullerton
BCBS of Nebraska has experienced similar benefits from integrating Wellframe with its systems, and it is currently implementing HealthEdge’s GuidingCare® digital care management solution. The integrated solution combines member experience with streamlined coordination across the care spectrum.
With GuidingCare, the health plan can seamlessly manage clinical and behavioral health needs, automate care planning, and target high-risk populations to provide whole-person care.
4. Digital Member Experience Establishes Competitive Advantage
By adopting a digital-first strategy, both health plans have positioned themselves as leaders in a market where exceptional member experience is essential to success. BCBS of Michigan has found that Wellframe has been instrumental in adding new members through its commercial line of business with employers:
“Customers tell us that our use of Wellframe sets us apart… It’s been a game changer in the RFP process… Wellframe has made a competitive difference for us in the market.” – Michelle Fullerton
BCBS of Nebraska has also experienced how Wellframe provides an advantage when competing for new business:
“Consumers are much more digitally savvy than they were five years ago, three years ago even. This suite of products really allows us to be…ahead of in many spaces.” – Dr. Josette Gordon-Simet
5. Digital Transformation Success Requires Change Management Strategies
Implementing digital tools like Wellframe is not just about technology—it’s about ensuring that an organization’s people and processes are ready to adapt to new workflows.
When BCBS of Michigan first introduced Wellframe, many nurses had spent years working in familiar systems. The shift to a digital-first approach required new skills and a change in mindset. To address this, BCBS of Michigan built a team of early adopters to influence the organization:
“You need a team of champions… Our early adopters helped guide their colleagues and supported those struggling to adapt to the new digital workflows.” – Michelle Fullerton
BCBS of Michigan prioritized regular feedback loops and continuous training to ensure a smooth transition. By listening to care teams, leadership addressed pain points, refined workflows, and adapted based on real-world usage. This fostered a culture of continuous improvement that empowered care teams to provide feedback and contribute to ongoing success.
BCBS of Nebraska employed a similar approach, ensuring their internal teams were engaged throughout implementation and understanding that adopting digital tools is an ongoing process that requires continuous refinement.
“By engaging our internal teams and making iterative improvements, we’ve created a better overall experience for both members and staff.” – Dr. Josette Gordon-Simet
By listening to their teams, learning from early challenges, and adapting their strategies, these organizations ensured that Wellframe helped them accomplish their goals.
The experiences of BCBS of Michigan and BCBS of Nebraska demonstrate that Wellframe’s member experience solution enhances member engagement and streamlines care workflows, driving meaningful improvements in health outcomes and operational efficiency.
Visit the HealthEdge website to learn how Wellframe can elevate your health plan’s member experience.
