Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

Top Ways Payers Integrate Patient Engagement Strategies

Public and private payers implement patient engagement strategies through provider collaboration, user-friendly tools, health information exchange, and beneficiary incentive programs.

By Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced last week the creation of the CMS Person and Family Engagement Strategy, The CMS Blog states. This CMS initiative is meant to stimulate patient engagement and bring the patients and their families into the clinical decision-making process alongside their physicians.

Health Information Exchange

Greater communication with the medical team can lead to a better patient experience and better quality of care. With health insurance companies still seeing rising healthcare costs across the country, patient engagement may be one way to target medical spending.

Public and private payers predict that patient engagement should lead to higher medication adherence, greater screening rates, and improved wellness. These steps should decrease overall healthcare spending among payers.

The CMS Person and Family Engagement Strategy seeks to bring patients closer to their primary care providers instead of relying on emergency or urgent care, which are costlier for payers.

The CMS patient engagement strategy focuses on reaching multiple goals including promoting user-friendly tools based on family/individual values, advancing patient engagement across the continuum of care, and creating the right environment for patients, families and physicians to collaborate effectively. Also, CMS is looking to create “meaningful measures and tools” to improve the patient experience.

“This Strategy emphasizes that person and family engagement goes beyond informed consent. It is about including the patients voice in policy and program planning,” The CMS Blog states.

“It is about building a care relationship based on trust and inclusion of patients’ beliefs, values, preferences, and culture which can even lead to a reduction in healthcare disparities. Healthcare decision-making should not always be limited to the patient and provider. It is essential to include family members, caregivers, and close friends in the conversation about health when the patient desires inclusion of others.”

Private payers can take the cue from CMS and invest in patient engagement as well. For example, insurers can work with IT companies and health information exchanges to improve the accuracy of claims processing and reduce the number of appeals. This would improve the patient experience and lead to greater member satisfaction. Creating new channels of communication can also bring greater patient engagement, said Ryan Rossier, Vice President of Platform Solutions at Medullan, last September.

“How payers and providers can help starts with, regardless of the channel being used, the focus on how the individual wants to communicate,” Rossier told “Recognizing what payers and providers can do as they work together as part of an ACO or other payer-provider network, is to put the member in the middle, provide different channels for the individual to select from, understand which channel is working for that member, and then promote more engagement of that member through that channel.”

By implementing a Medicaid program resource for individual agencies, CMS has put in efforts over the last year in advancing health information exchange solutions including Medicaid IT systems that can span across states.

Commercial payers would benefit from integrating patient engagement strategies since these methods could lead patients to take a more active role in their health and potentially reduce high medical spending associated with emergency room visits or hospital admissions. One way payers could incentivize their members to focus on wellness is through beneficiary incentive programs.

Beneficiary incentive programs are meant to stimulate members into focusing on their health and wellness as well as preventing disease progression such as through regular exercise and medication adherence. Under the Affordable Care Act, state public payers can apply for grants to create beneficiary incentive programs and boost patient engagement.

Some of the key goals to qualify for the ACA beneficiary incentive grants include creating a program centered around weight management, reducing blood pressure and cholesterol levels, preventing diabetes, and smoking cessation.

In order to reduce rising healthcare spending, health insurance companies, public payers, and primary care practices are advised to engage patients in wellness and disease prevention.


Dig Deeper:

Key Steps for Payer Success in Accountable Care Organizations

How Medicare, Medicaid, and CHIP Guide the Health Payer Industry


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