- The inability of consumers to successfully navigate the healthcare system, which costs employers and health plans billions in administrative costs.
In a recent article in the Harvard Business Review, members of Accenture’s healthcare practice laid out strategies for health plans to help consumers efficiently access care and thereby reduce waste.
Now, in the short run, no one can do an end-around on systemic complexity. That said, health plans can alter their approach to services to help ease and simplify the navigation of the healthcare system by allowing consumers to choose one-click options seen in other industries, most notably Amazon.
Recent studies have shown that while customer satisfaction among commercial health plan members is stable or improving in most of the country, overall satisfaction scores for health insurers remain one of the lowest industries.
“Commercial health plans have been battling a perfect storm of rising costs, payment reforms and consolidation, which has distracted them from focusing on improving overall customer satisfaction in the sector compared with other industries,” said Valerie Monet, previously senior director of U.S. Insurance Operations at J.D. Power and now senior director, Strategy and Insight, at Banner Health.
“Amidst the consolidation activity this past year, the one area where top-performing health plans can really set themselves apart in the eyes of their members is to help them better understand how to navigate the healthcare system, including how their plan works and cost-effective access points for care. The key is effective communication.”
Health plans should deploy product tailored to consumers with varying levels of healthcare literacy. For some strategies, both health plans and provider groups have a role to play, even if one bears more responsibility than the other for an aspect of the patient experience, according to the Agency for Healthcare Research and Quality.
Health plans, for example, can equip providers with the skills, tools, and information systems they can use to improve their communication with patients. Payers can also play an important role in incenting medical groups, practices, and individual physicians to improve the patient experience.
While several measures in the CAHPS ambulatory surveys address issues beyond the direct control of health plans, the latter can exert some influence over medical groups and individual physicians depending on their relationship with these providers. Health plans that own physician practices and/or employ physicians tend to have greater influence than those accounting for a minority a practice’s patients.
Patient experience surveys such as the CAHPS sometimes are mistaken for customer satisfaction surveys. Patient experience surveys focus on how patients experienced or perceived key aspects of their care, not how satisfied they were with their care. For example, CAHPS focuses on asking patients whether or how often they experienced critical aspects of health care, including communication with their doctors, understanding their medication instructions, and the coordination of their health care needs.
Health plans operating independently and in conjunction with other stakeholders (e.g., large employers, local purchasing coalitions, government purchasers) have created public “report cards on provider performance. These reports yield comparative information on the performance of hospitals and medical groups on various quality measures, including CAHPS. Their members are encouraged to pay attention to the quality of their providers and opt for high performing medical practices and physicians when health plans make the reports available. Furthermore, health plans can publicly recognize high performing providers in their network as part of the programs.
Through private reports that evaluate their performance on various aspects of quality, health plans also provide healthcare providers with helpful information, substituting or complementing public performance reports. In some instances, health plans first share private reports then introduce public-facing versions once providers further familiarize themselves with assessing quality and methodology.
More detailed information often is included in private reports than those available publically. That way, providers can more effectively pinpoint components of the patient experience in need of an upgrade. For example, private reports may contain results stemming from individual survey items, along with patient complaints and feedback summaries, shedding light on common issues that require attention.
On top of that, private reports typically more deeply compare the performance of individual providers and/or groups to peers and other benchmarks (e.g., local, regional, national) as well as “best-in-class” performance. Not only does this approach fuel the desire in providers to outperform their colleagues, but it also sparks communication on ways to improve performance on quality measures.
Health plan payments to providers play a critical role in motivating them to address patient experience. Payers have already adopted payment programs that financially compensate providers for value over volume, but it remains paramount for health plans and providers to reach a mutual agreement on the size and structure of incentives to help P4P and other value-based payments programs spark improvement.
Effectively communication with patients at every touch point is the primary challenge that health plans must address.