Healthcare Enterprise Management Platform for High-Touch Member Engagement
David J. Sand, MD, MBA
December 1, 2022
Member engagement: the “holy grail” for health plans. As a chief medical officer in multiple health plans, I cannot tell you how much time my staff spent attempting to contact and interact with our members. Contact rates for case managers were better than 50%, yet actual enrollment in our programs was less than 10%. Our success rates rose significantly when we delegated the engagement task to some of our specialty vendors, such as remote patient monitoring or in-home palliative care, who had honed their expertise in motivational interviewing and were skilled in their ability to communicate their value. Contact rates skyrocketed from 14% to 47% when our vendors were able to put the health plan’s number in the caller ID. We knew we had something to offer; knew we could help our members lead healthier lives; knew we could reduce their financial burden of copays and coinsurance payments; and knew we could keep them safer and reduce over-medicalization — if only we could get through.
High Tech – High Touch for Care Management
In 1999, John Naisbitt published the book “High Tech High Touch: Technology and Our Search for Meaning.”
As prescient as his writing was at the time, our technology has continued to evolve unabated. As we now look at the intersection of technology and health care, with a specific focus on care management, we are well advised to remember even the most powerful technology we have is just a tool for humans to use — not the end of human involvement whatsoever. Searching for increasing efficiencies and ever more automation, we run the risk of further isolating ourselves from our members rather than our intended goals of engaging them and bringing them closer. Yet, with thoughtful use of the information that’s literally available right at our fingertips — in addition to remembering we are working with people in very personal situations while sometimes discussing emotional topics — we can yield insights to inform how we can actually connect with each other.
The Only Thing Worse Than Not Asking Is Asking Members and Not Listening
People are often frustrated with their health insurance company yet have limited opportunity to express this frustration outside of a specific instance in which they want a service or item covered. Of course, we can — and often do — survey members, but do we listen and pay attention to the responses we receive and carry that knowledge forward? Without listening properly and taking actions based on member responses, case managers, HEDIS® staff, specialty vendors, and other critical stakeholders run the risk of creating significant member abrasion by creating the perception that you’ve already asked the questions but ignored the members’ answers.
What It Means to Provide “Concierge Service” in Healthcare
To truly provide the concierge experience and successfully engage your members, your associates need to have as much information as possible about the member while they are in the process of working with that member. The vast majority of this information comes from an enterprise management platform. Additional pieces of information may come from integration with vendor systems, CRMs, and other point solutions. The critical point is that the management platform is the single source of truth and provides not only the richest source of information, but also the necessary tools to act on that information effectively and efficiently. No specialty vendor can credibly make a representation otherwise.
Your Healthcare Enterprise Management platform provides your clinical staff and customer service representatives with the information they need to:
Close Quality gaps
Understand the programs in which your members are already enrolled, those they have declined, and avoid asking the same questions again
Engage members according to their preferences
See additional options available which may be of benefit. Examples of these options include social assistance resources or medically tailored, home-delivered meals after a hospitalization. No CRM or point solution can do this.
Years ago, I worked with a Pulitzer Prize winning journalist at the Wall Street Journal. Even he was astounded by how much data we had in just the claims files. Back then, our ability to ingest, clean, normalize, and aggregate data from myriad sources was limited, as was the available data. Today, it’s a very different story. We literally have more data than we know what to do with. Our ability to leverage these data is limited only by our curiosity and imagination. A health plan is a living organism — whatever happens in one area has effects across the entire enterprise. An enterprise management platform that tightly integrates health plan functions is essential to making full use of the information gained from synthesizing these data points.
This tight functional integration can only be obtained with an enterprise management platform that is specifically designed for health care. If you invest in a platform that’s not designed for health care, you will find many of the functions of the enterprise are divided among various vendors. And if the vendor running the show has no pedigree in health care at all, the more fractured and less valuable the information becomes. Healthcare enterprises have seen entrants from unrelated verticals who believe they can piece together solutions, but in reality, they leave the integration burden to the client. Many of these entrants do well in their own spaces yet lack the experience gained from decades of doing business in the extremely complex healthcare space.
Having the most comprehensive and trustworthy information about your members shows them you really do care and have listened. In an increasingly complex and technological healthcare system, the ability to provide the “high-tech, high-touch” concierge member experience is dependent on a cohesive and fully integrated enterprise management platform — designed by healthcare experts — to keep all that information at your fingertips.
Contact ZeOmega to see how Jiva, our healthcare enterprise management platform, can help your organization provide an unparalleled member experience.
David J. Sand, MD, MBA
Chief Medical Officer for ZeOmega
As Chief Medical Officer, Dr. David J. Sand provides overall clinical vision to the organization, helping to ensure the safety, effectiveness, and relevancy of ZeOmega’s thought leadership. He also provides clinical direction on product development, positioning, and relevance for the company’s evolving markets.
Dr. Sand is a board-certified otolaryngologist-head & neck surgeon. After dedicating 12 years to a solo clinical practice, he transitioned to become the chief medical officer of Permedion, a URAC-accredited IRO in Ohio and HMS, a national program integrity vendor to 46 different state Medicaid agencies and the CMS. Since then, Dr. Sand has served as chief medical officer in multiple Medicare Advantage and Medicaid health plans. Most recently he was chief medical officer of Care N’ Care, a provider-owned Medicare Advantage Plan in Texas, and as the national chief medical officer for Medicare for Anthem BCBS.
Dr. Sand has participated on the board of the National Association of Independent Review Organizations (NAIRO), the American Diabetes Association, and has been a Fellow of the American College of Surgeons, the American Institute of Healthcare Quality, the Institute of Medicine of Chicago, and the American Academy of Facial Plastic and Reconstructive Surgery. He has also spoken nationally on fraud, waste and abuse, palliative and end of life care, and quality improvement.
Dr. Sand received his Bachelor of Science and MD degrees from Brown University in Providence, RI, and his MBA with honors from Regis University in Denver, CO. He served his surgical internship at Pennsylvania Hospital in Philadelphia and his otolaryngology residency at Temple University Hospital in Philadelphia.