How to Personalize Chronic Disease Management through Concierge Care

June 21, 2023 - Updated 6/21/2023: This article has been updated to correct a name and title error. The interviewee's name and title have been corrected to "Anthony Nguyen, chief clinical officer at Elevance Health." A previous version incorrectly stated "Andrew Nguyen, chief medical officer at Elevance Health."

Chronic disease management is a marathon, not a sprint. As anyone who has ever engaged in a long-distance sport or an endurance-oriented achievement will know, such activities are as much about mental fortitude as they are about physical ability. Athletes develop various practices for maintaining focus and stamina.

In some ways, members with chronic diseases and the healthcare stakeholders that assist them may need similar practices to sustain adherence to disease management programs. But many chronic disease management supports are not designed with this mentality, leading to low and temporary member engagement rates.

Challenges around user retention are particularly noticeable in the healthcare app world.

For example, up to 20,000 mental health apps exist, but studies show they fail to keep consumers engaged for prolonged periods. In one study, almost seven out of ten mental health app users opened apps on the day they downloaded them, but by the fifteenth day, only 3.9 percent of users opened the apps.

Apart from struggling to keep members’ interest, payers tend to create chronic disease management solutions that are excessively narrow. Programs that address only one disease may not effectively serve more than one in four US adults who have two or more chronic diseases.

To support a member with Crohn’s disease, diabetes, or another chronic condition holistically, a chronic disease concierge solution should acknowledge and address all the member’s conditions.

Concierge medicine may provide a solution to these challenges. Also called “retainer care,” “boutique care,” or “direct care,” the concierge care model involves an annual membership fee to cover a provider’s services. In exchange for this fee, providers state that the model offers faster access to care and a closer provider-patient relationship.

Anthony Nguyen, MD, chief clinical officer at Elevance Health, sought to avoid the common program pitfalls of low retention and narrow scope through the Concierge Care program. In partnership with Elevance Health's subsidiary brand Carelon, Concierge Care aims to facilitate stronger relationships between members and their nurses through digital-first, concierge-style services.

“The program is unique because…it first tries to establish trust and create a relationship, and that's really the key when we started building out this program,” Nguyen told HealthPayerIntelligence. “It starts with authenticity and trust, and how do we make that connection.”

First, the program evaluates members’ personality types and Elevance Health nurses’ personality types. The payer categorizes members with chronic conditions into five archetypes. When members download the app, Elevance Health pairs them with a nurse whose type resonates with theirs.

The personality type might indicate what approaches will be most effective in motivating the member. Some individuals are achievement-oriented and will be most consistent when given goals to pursue. Other individuals are family-oriented and are more likely to engage in their health if their families benefit or can be involved.

Members might match with their nurses on a variety of characteristics beyond personality as well. For example, if the member is a single mother or if her family comes from a certain area, the payer might match this member with a nurse who is a single mother or who also comes from that area.

Matching based on personality type helps nurses to know what will motivate their members to stay engaged with their health. It facilitates trust and helps nurses understand and support members’ objectives.

Once a member is matched, they pursue a 12- to 16-week course on the Elevance Health app. Although a provider might prescribe the app due to a specific chronic disease diagnosis, the course aims to support members’ health holistically, addressing comorbidities as well as chronic conditions.

The payer gamified the program to maintain member engagement by giving members badges after completing certain milestones and integrated personalized nudges. These aspects not only help keep members’ interest but also maintain a sense of connection and individualization.

While members still have access to the program’s resources after finishing the course, they are not committing to a lifelong program that quickly becomes a chore.

Reflecting on the outcomes of this program, Nguyen highlighted a few factors behind a strong concierge care program that can improve chronic disease management.

Emphasize personalization to improve member engagement

Personalization affects various aspects of the program’s design, with creating a personalized care plan being the program’s ultimate objective.

First and foremost, members are paired with nurses who mirror some of their own personality traits or background characteristics. Developing archetypes is considered a strong tool in personalization and quality of care improvement. Members’ providers can also get involved in the course and customize the curriculum if desired.

When a member’s engagement has stalled, the program encourages her through the app in a highly personalized manner based on app and claims data.

User data informs Elevance Health about the times of day that the member tends to be active on the app. The program then sends a reminder to the member at the optimal time when she is most likely to see it and respond.

Beyond timing, the Concierge Care app pushes content to members in a selective manner based on the member’s demonstrated interests. For example, if a member watched one of the Concierge Care videos on high cholesterol, the app might surface a video about nutrition for her to watch next.

The concierge team uses claims data to know what information a member might need. And app user data indicates when the member stopped watching a video, giving insight into the member’s level of interest in certain topics.

Part of personalizing a chronic disease management plan is giving members the power to include others in their journeys. As a result, enabling shareability was crucial.

One of the key reasons why Elevance Health delivers Concierge Care as a digital-first program is to allow members to share information more freely. The digital-first format allows members to send videos and milestones to their community. This both streamlines communication and activates the members’ support systems.

Beyond patient education, Elevance Health’s goal is to educate members’ social ecosystems, including family, caregivers, and medical professionals, to improve member engagement and care coordination.

Know when less is more in member education

Patient education is a known factor in successful chronic disease management. Studies have demonstrated that patient education can affect both biomedical and psychological outcomes for patients with chronic diseases and that combining care with digital disease education efforts can improve patient engagement outcomes.

But it is important for payers to know when less is more in patient education for chronic disease management, Nguyen emphasized.

In Elevance Health’s 12- to 16-week course, patient education is a critical component. The course materials offer an overview of the member’s chronic disease. With a strong grasp of the essentials regarding symptoms, flare-ups, and strategies for managing flare-ups, members and their providers can create a personalized disease management plan.

Members can watch videos that share key information about their conditions and can text their nurses to get answers to their questions in real time.

However, members should not expect to know everything about their conditions after participating in the Concierge Care program because that is not the program’s goal.

“The program is absolutely not comprehensive as if you took a whole semester on Crohn's because it's a lifelong journey, and we know that,” Nguyen explained. “What we want to do is empower you to feel confident enough to manage your disease state.”

Given that chronic disease is a lifelong journey, payers should give options for continuing education. In Elevance Health’s program, the member stays connected with the nurse and the app remains active with all of the course content. The payer also encourages members to connect with peers in the same patient population through the payer’s app, Sydney.

Redesign nurse training, metrics around personalized concierge care

Hinging chronic disease management on a strong member-nurse relationship may require a payer to reimagine its nurse training process.

Previously at Elevance Health, the nurses were given a curriculum and trained on how to engage members over the phone.

The concierge nurse training was more personality-based. Nurses voluntarily took a personality test to determine their types. They also got certified in the patient archetypes to hone their member engagement capabilities with specific personalities.

“It’s a complete mind shift,” Nguyen said. “It's not just ‘here's our program, here's what we all go through, here's the nurse that we just happen to assign to you.’ It is built around the individual. The pace might be different. The content in terms of the wording is different based on your personality and the matching. It is a much more consumer-centric approach than we've ever taken before.”

Nguyen noted that nurses enjoyed this approach to member engagement more than traditional strategies. They found that their relationships with their members were much more authentic.

Elevance Health also adjusted its metrics for this program to support its member experience-centered goals. Instead of placing utilization and emergency care measures at the center of their quality measurements, Nguyen’s team focused on engagement. They sought to gather data on questions like:

• Were members downloading and opening the app?
• Were members using the app?
• Did members find the information on the app valuable, educational, and engaging?
• Did members consider Elevance Health and its Concierge Care program to be a trusted source of information on their conditions?
• Do members feel more confident about managing their disease states at the end of the program?

Nguyen found that the program’s member engagement results were positive. The Concierge Care app demonstrated strong retention trends. Six out of ten users were still active on the app over a week later. Over half of the users started chats with their concierge team and many continued to connect with their nurses and used the app even after completing the course.

Nguyen and his team gathered common metrics in addition to member engagement data and saw improvements among Elevance Health’s members participating in Concierge Care. For example, emergency room utilization for the oncology program dropped by almost 40 percent. Symptoms and flares in the Crohn’s disease program improved by 25 percent.

With chronic disease diagnoses among individuals 50 years and older projected to increase 99.5 percent by 2050, payers have the opportunity—and, some might say, the imperative—to refine their chronic disease management programs and improve member engagement.