Drive Member Satisfaction through Digital Tools: Insights from AHIP CDF 2024
Member satisfaction is vital for health plans to grow communities and improve outcomes. At the AHIP Consumer Experience & Digital Forum (CDF) 2024, Susan Beaton, Vice President of Health Plan Strategy at HealthEdge, addressed this topic with her presentation on “Driving Member Satisfaction Through an Integrated Care Management Strategy.”
The presentation highlighted how integrating digital tools with traditional workflows can transform care management delivery to drive member satisfaction. This is especially important considering care managers’ increasing responsibilities, the direct connection between member experience and satisfaction, and the rising demand for innovative digital solutions from members.
Key takeaways from the presentation include:
1. Care Managers Face Increasing Responsibilities And More Significant Challenges Than Ever Before
Care managers face rising challenges as their responsibilities expand to address a wide range of complex business and member needs. Workforce shortages make their role even more complicated, while manual administrative tasks take up valuable time that could be spent on direct member care. Members’ expectations are rising for more personalized interactions and immediate information. Navigating complex regulatory requirements only adds to care managers’ workload while they perform an essential role in a member’s care journey.
2. The Care Manager’s Experience Directly Impacts Member Satisfaction
Improving care managers’ experience through digital tools enhances efficiency, improves member outcomes, and increases satisfaction. Streamlining their workflows and providing user-friendly tools that reduce manual administrative work allows them to apply their expertise effectively, so they spend more time addressing member needs and providing personalized and proactive care. Care managers who are empowered to consistently anticipate and meet member needs foster trust with members, drive better health outcomes, and create a more positive overall member experience.
3.Members Expect Innovation And Are Comfortable With Digital Tools
As technology transforms members’ daily lives, they are increasingly comfortable using digital tools to manage their health. The 2024 HealthEdge® Consumer Survey found that 64% of members are comfortable using mobile apps to access health information, while 65% are open to utilizing AI-powered tools provided by their health insurers. These findings highlight the rising expectations for innovation and digital engagement in healthcare, as members now anticipate seamless, technology-driven interactions like those in retail, travel, and other areas of their lives.
4. It’s Time For Health Plans To Rethink Care Management Delivery
The increasing challenges for care managers, alongside rising expectations from members, present an opportunity for health plans to apply modern technology to enhance traditional workflows. Integrated Digital Care Management merges traditional care management practices with digital tools and technologies to improve efficiency, effectiveness, and reach. This approach combines clinical data, real-time member insights, and traditional care workflows to create a more efficient, member-centered approach, ultimately improving the care experience and delivering better health outcomes at lower costs.
A HealthEdge study using Wellframe data highlights how digital tools dramatically scale care management resources and boost member engagement with the same staff levels, leading to results such as:
- 2x increase in active caseload size, allowing care managers to handle more members without additional staff.
- 6x increase in member interactions, driven by enhanced digital engagement and self-service tools.
- 91% increase in successful outreach that improves care delivery and ensures members receive timely support.
This data shows how integrating digital tools can significantly enhance the effectiveness and reach of care management programs.
5. The Benefits Of Digital Tools Are Accelerating
Integrating digital tools in care management is proving transformative, significantly enhancing operational efficiencies and the scope of services to members. The benefits are only accelerating as tools become more mature and advance integrations with other platforms to streamline care team workflows. Additionally, sophisticated digital tools incorporate artificial intelligence (AI) technology into their platforms to drive further efficiencies and member personalization. These accelerated benefits support various business initiatives, from launching concierge services that provide targeted clinical support to identifying and driving new initiatives to improve the member experience and member satisfaction.
6. Successful Adoption Of Digital Tools Requires Change Management Best Practices
Organizations must prioritize robust change management strategies for digital tools to be effectively adopted by care managers and integrated into their daily workflows. This includes pillars such as focusing on the care manager’s experience with new tools and ensuring leadership commitment to transformation. Key strategies for success include digital transformation, aligning incentives, and collaborating with the right vendors to support long-term goals. In addition, health plans can benefit from intentional rollouts of new tools that focus on optimal use cases to establish high impact, early success, and internal buy-in.
7. The Time Is Now for Integrated Digital Care Management
As the healthcare industry evolves, the need for Integrated Digital Care Management is more urgent than ever to drive member satisfaction. Strategic concerns for health plans include the following:
- Market Dynamics and Consumer Expectations. With more health plan options available, members expect healthcare experiences that mirror the convenience and immediacy of digital retail services, which is crucial to drive member satisfaction.
- Regulatory Pressures. New regulations focusing on health equity and social determinants of health (SDOH) data require modern digital tools for compliance, which can impact member satisfaction scores and financial incentives like Star Ratings.
- Operational Efficiency and Cost Reduction. Digital tools, automation, and AI streamline administrative tasks, helping health plans do more with fewer resources, while alleviating the workload of care managers.
- Competitive Advantage. By adopting Integrated Digital Care Management, health plans can position themselves as innovators, gaining a competitive edge in attracting and retaining members, while preparing for future technological advancements.
Beaton’s presentation from AHIP CDF 2024 provides a roadmap for health plans to leverage digital tools to elevate care management practices, and enhance member and care manager experiences.
Using the Wellframe solution, a Blue Cross Blue Shield plan drove member engagement and increased care management capacity to better serve their 21 million members. To learn more about how the health plan improved phone call success rates, active caseload size, and member interactions, read the case study.
