Troy Jelinek, PhD, MHA Chief Commercial Officer at Icario.

Effective communication builds stronger relationships, and that’s no different when it comes to health insurance plans and their members. Thoughtful and proactive engagement has always been a reliable way to get members to take action on their health and help close gaps in health equity, but it’s now a “must-have” instead of a “nice-to-have.”

It’s clear that health equity has become a higher priority in recent years. For example, the National Committee for Quality Assurance introduced new quality measures, including the Social Need Screening and Intervention measure. These measures encourage health plans to screen members for social needs related to food, housing and transportation and provide timely interventions to promote health equity.

There are three pillars that health plans should consider in their efforts to improve the member experience and impact disparities in health equity: data surrounding social determinants of health (known as “SDoH”), personalized communication and a strategy that accounts for both social and clinical factors.

Closing Care Gaps Through SDoH Data

There are a variety of ways health plans can collect SDoH data on their members, including:

• Self-reported data: Don’t just use survey data; also leverage lived experiences and qualitative data, and then look for patterns and themes within the data. This not only helps plans learn about individual members but also wider overall communities as well.

• Predictive data: Use ZIP codes and extrapolate educated guesses based on population data. Over time, this will reveal trends within member communities.

• Combining the two: Using a mixed-method approach is a powerful way to learn from imputed data and then fill in the blanks with survey data. The end result is a fuller 360-degree view of members that helps inform more intelligent decision-making.

All of this data can help improve the member experience because it gives plans a better understanding of members’ needs and priorities. Similar to how most consumers appreciate a smart recommendation from a retailer, plan members value when they feel the plan is looking out for them.

A New Necessity: Personalized Communications

Improving the member experience starts with using language that is understandable to the individual member. Everyone is different in what motivates them. Tailoring content so it’s personalized to each member not only drives health actions but also acknowledges the member and shows them you care.

The language must also be approachable and provide access. When it comes to digital health and telehealth, for example, access to high-speed broadband must be considered.

Plans should also work to refine their outreach to historically non-compliant and underserved segments of member populations so they can move the needle on health equity and address specific SDoH barriers. By doing so, plans don’t overspend on offering supplemental benefits, making it a cost-effective way to segment, target and engage the hardest-to-move populations.

Finally, communications should use inclusive language, specifically the member’s native language. Health literacy barriers can only be tackled after starting from a point of cultural competency. In relation to health equity, plans should focus on creating “equal experiences” for members whose primary language isn’t English, going above and beyond direct translation to reach members in the right language and the right channel with the right message at the right time . When you understand the message, you’re more likely to take action. Getting the language right and designing it to be an equal experience is a pivotal step in advancing health equity, building trust and moving people to better health.

In addition to simply being the right thing to do, this must be visible in health plans’ call center measures; this will be reinforced heavily under the Centers for Medicare & Medicaid Services’ 2024 Medicare Advantage and Part-D Final Rule, meaning it will no longer be just a Medicaid or Dual Eligible Special Needs Plan issue.

Leading With Social And Following Up With Clinical

The final pillar in improving the member experience is a strategy that addresses both their social and clinical needs. In most cases, it’s most effective to begin by addressing whatever social issues the member faces before drilling down into the medical requirements they might have.

For example, imagine a person with diabetes doesn’t have consistent access to healthy food. I’d encourage plans to address this specific issue first through supplemental benefits and then focus on getting members the physical healthcare they need, such as setting up appointments with physicians, into an exercise program or agreeing to a medication adherence program. The thinking is the members won’t be motivated to take action on their health until they feel more secure about their social disparities.

There are no easy answers when it comes to addressing health equity, but health plans can make significant strides in the right direction by recognizing the social issues affecting members and addressing them to improve the overall member experience. Customer satisfaction and loyalty are powerful in the consumer realm, and member satisfaction and loyalty can be just as important in healthcare. Plans that understand this can lead themselves to the ancillary benefit of improved plan performance and, most importantly, improved outcomes among their member populations.


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