Kaitlin Howard

By Kaitlin Howard

Kaitlin Howard is a researcher and writer producing insightful content across the healthcare revenue cycle. She has written and produced content for Zelis, Waystar, and Recondo Technology, as well as agencies. With a B.A. in English and Writing from University of Denver, Kaitlin stays current on market updates on claims management and healthcare payments, publishing a regular educational blog series on industry trends and Zelis offerings.

It’s time to focus on the member.

Members are becoming more determined to take ownership of their healthcare information. Many express a desire for solutions that provide clarity, control, and guidance. As such, organizations should look to develop solutions with transparency and education in mind, further empowering members on their journey and providing support at every step along the way.

And while we know the member empowerment space is challenging, with the right tools and mindset, all of us here at Zelis truly believe healthcare organizations can take the steps needed to push their strategies one step further.

In a recent podcast, Kevin Tierney is joined by Madison Goldfischer​​, Zelis Vice President and head of product for member empowerment, to unpack a recent member empowerment study from Zelis and to better understand what these results mean for the future of the healthcare industry.

As always, we’ll discuss the highlights below, but you can listen to the full podcast here:

Step One: Establishing trust

In Zelis’ recent member empowerment study, one of the most cited reasons for disengagement was broken trust. So what can plans do to reestablish trust and provide more member clarity?

Plans need to be deliberate, telling members what they’re getting and why. Explain how benefits work, how healthcare works, and how members can leverage their benefits.

Members should understand how to do things themselves, but that doesn’t mean they should have to go it alone. Continue to lead them to the right choice but give them the autonomy to make the choice.

Step Two: Gaining clarity

Lack of member engagement boils down to this: the traditional healthcare journey we support is fundamentally flawed.

But it’s not your fault. In fact, it’s not even close.

With the rise of cost comparison tools, the importance of understanding of out-of-pocket cost is vital.

The average American has under $1K set aside for emergency funds. Now add in deductibles, out-of-pocket payments, and co-pays. Talk about stressful.

But that’s only the first bit.

Finding care and understanding what to do for care as it relates to the member’s specific situation is a massive touchpoint that can sometimes be overlooked.

Post-care is the same.

How many times have you received a paper bill months after receiving care? The answer, if you’re like other Americans, is probably “too many”.

For many, once the bill is received it can look like jargon. What does an EOB mean? Why do the numbers look different on different pages? Is the amount correct? Is this the final bill or will there be another?

People need support. They need answers. And they need it quickly and simply.

That’s where you come in.

Intermission: The challenge

Members in high deductible plans are less likely to receive appropriate care, especially those trying to manage conditions, because, when it comes down to it, many just don’t understand what it is going to cost them, so they neglect all care in general.

And that’s a problem. A big one.

When considering long-term care costs, ideally, you want to manage the appropriate amount of care upfront, so you can stem off any major issues further down the road if need be.

But that doesn’t always happen.

With an increase in employee turnover, many consumers may have a different plan every year. As such, some health plans are feeling a strain when attempting to provide a corresponding, continual experience.

Step Three: Meaningful guidance

Health plans should provide meaningful guidance to members along their healthcare experience before even talking to a real person. How? Implementing proactive digital self-service tools.

Technology is robust enough for consumers to be proactive about how they engage.

Websites and portals need to, not only, have enough information, but also, be easily navigable and, more importantly, individualized.

If a member has a chronic condition, their care journey, as well as the information they need, is going to look a lot differently than a healthy member.

Ensuring your digital, self-service tools reflect each member’s experience is so important. And a great first step.

But we’re all still human. And being human comes with complexity.

That’s where the person-to-person interaction comes in.

Step Four: Capturing confidence

When a member has more confidence in their healthcare journey, a few things happen:

One is the willingness to increase ownership and engagement in their own healthcare journey.

The other is a willingness to engage in things in which they wouldn’t have normally trusted.

As you build out member confidence in the basics of healthcare and your own products, overtime, you’ll be able to start incorporating components to help members better manage both their current and future care.

The Wrap Up

Experience is everything. As such, taking a human-centered approach is vital to ensuring a smooth-sailing healthcare journey for members. Because, as you know, members are people, first and foremost.

If you’re interested in finding out how Zelis can support your organization’s path towards member empowerment, click here.