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.

If you’ve been reading our blog, you know in a recent podcast, Kevin Tierney of Future Healthcare Today was joined by Madison Goldfischer​​, Zelis Vice President and head of product for member empowerment, to unpack a recent member empowerment study from Zelis discussing what members expect from their plans and providers.

Well, the duo is back. And this time, they’re focusing on the healthcare journey as a whole.

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

The evolution of the member journey

Patient engagement has evolved. We all know that. Patients are better informed and more actively engaged in their medical care than ever.

And there’s no doubt in anyone’s minds that technology has served as a key catalyst in driving this increased involvement.

The 2010s began with the implementation of the Affordable Care Act (ACA) and ended with a deluge of big tech and retail ventures that blurred traditional healthcare boundaries. As such, healthcare’s current combination of technological revolution and burgeoning scientific and patient insight has created a unique opportunity for transformative possibilities across the industry.

Now add in the advent of telemedicine.

COVID-19 changed nearly every aspect of the patient journey, accelerating the need for digital transformation industry-wide. Telehealth, touchless engagement, and self-service scheduling became the new normal.

Consumers now expect 24/7 access to their healthcare journey and all the resources that go with it (e.g., care records, payment plans, health insights).

And that’s just the beginning.

Member satisfaction: the highs and lows

In Zelis’ member empowerment study, we found a few common places where members from across the care continuum were less satisfied.

One area in particular where we saw a massive drop was post-care (aka actually receiving the bill).

Of course, no one likes getting a bill, but this dip in satisfaction seemingly had more to do with the complexity of the current billing process rather than the bill itself.

What does EOB mean? Why do the numbers look different on different pages? Is the amount correct? Why did I get two bills last time and only one this time? Am I missing something? Should I pay this now or wait? Is this the final bill, or will there be another?

Another area for improvement was complex care.

Those with chronic conditions or receiving a complex procedure had a higher level of confusion regarding patient benefits than other members.

This may be due, in part, to the frequent introduction of new types of care within their care plan.

Think: my doctor said I need to get X treatment, but is that actually covered by my plan? What will it cost me out-of-pocket? Have I reached my deductible?

On the other hand, this group of members found a high level of satisfaction surrounding the basics of finding care.

But jump-starting your organization’s member empowerment strategy is threefold.

The first step is an upfront deployment of solutions that really drive clarity of cost. The second is prioritizing member understanding through clear, plain language so you can provide guidance on and help reconcile the bills they receive from providers. The third is ensuring consumers feel a sense of control over their healthcare.

The ideal member experience

Let’s do an example.

Take, for instance, buying an airline ticket.

You know your costs upfront. You’re able to compare prices and find one that works for you. You purchase your ticket after viewing a real-time generated bill and know that you’re set for your flight. On the day of your flight, you arrive at the airport and check in using either their customer service desk (where you know you’ll receive all the information you need) or at the touch of your fingers on your airline app. Then, all that’s left for you to do is make it through security and wait for your flight. Easy, peasy.

The take-away? The consumer is in full control of their experience with clarity on current and next best steps.

Consumers want that same level of comfort during their healthcare journey. Think: owning their data, controlling their journey, deciding what their next step should be, and doing all of that with help and guidance from their provider and plan.

The wrap up

The role of the patient has evolved from passive engagement to an integrated partnership. As such, we must ask ourselves what is possible? How can we continue to leverage technology to drive the member empowerment? How can we learn from and incorporate the insights of patient experts?

The opportunity for transformation is now.

If you’re interested in finding out how Zelis can support your organization’s journey toward member empowerment and satisfaction, download our latest playbook, Health Plans Must Provide Members with Clarity, Control and Guidance.