Kristin Gasteazoro, senior vice president of SmartShopper® Sales and Client Performance, sat down with Future Healthcare Today to talk all things care guidance. Take a listen to hear her thoughts on using care guidance solutions to boost member satisfaction or get the highlights below.
Q: Why are care guidance tools important for members and how can omni-channel solutions benefit members?
KG: Coming from the perspective of healthcare, members know how to search for their doctor, for example, or Google their condition. In fact, 70,000 healthcare-related searches happen every minute, 75% of patients use Google to find their doctor, and 71% use online reviews. Why do we do this for something as important as healthcare?
Think about when you’re searching for a restaurant, or you need to identify a local carpenter. I use my friends—phoning or texting them—and I use the internet. If I’m online, I read what other people’s experiences were, and I take those inputs and make a decision. Yet in healthcare, which is so important to my mind, body, and soul, we trust a digital marketplace over our health plan or provider.
This is where I like to take a step back and look at it from the perspective of the consumer world. I’ll give you an example. Say, booking a flight. I have three options: I can call Delta, which means I risk a wait. I can text Delta. There’s minimal risk that way, but I might not get exactly what I want from that interaction. Or I could use my Delta app to book the trip myself. The risk is taken out of my choice because I’ve been given so many options that at any given time, if something doesn’t go as planned when booking online or in the app, I can always phone Delta and talk to a representative or text them to get help. Healthcare needs those same options, and they need them to help a member understand how to make appropriate healthcare choices.
Q: So how can these solutions close the care gaps and why is it essential for all parties involved?
KG: So intrinsically I know I need to go to the doctor, but extrinsically, I may not have the motivation to go. I might be too busy. I can’t find a provider I like. It takes me too much time to call, and I hate calling into a call center. Now, with that in mind, let’s look at it from the consumer world. We’ll use Target as an example. When I use their Circle Rewards at point of sale, I enter my cell phone number—every single time. I don’t even think about how they’re going to use that number. And miraculously behind the scenes, I’m earning rewards that I can use at any point in time to ultimately influence where I do my shopping. I will go to Target over other competitors because I align myself to that reward structure.
Members respond very well to rewards like that. They do it every day. Just like me at Target. When you think about it, there is evidence of positive impact when states use financial incentives to motivate managed care plans. Why not apply those same incentives to members? Put some skin in the game for them to have the opportunity to make a choice.
Typically, when you work in the government programs, your biggest challenge isn’t the people who are historically compliant—the people who will go get their annual screenings—it’s the people who won’t do it. And that’s why extrinsic motivation is so important as part of care-gap solution closure. And why it’s essential that your strategy can’t just be at the provider and plan level. You have to think about the members, and it has to influence the way they access their healthcare.
Q: Do you think a rewards program is possible to implement to benefit the members? Is that feasible?
KG: Yes! Just look at what’s happening with commercial health plans. They have a whole playground of wellness incentives and rewards. Take a points rewards system, for example. Let’s say a member gets 100 points for every 10,000 steps they walk. If I’m a member with a weight loss goal, I’m going to walk 10,000 steps a day. But I’m not going to reach that goal next week. I might want to, but it’s not going to happen. There’s longevity in the rewards when you see results.
When you think about reward and incentive solutions from a Medicare, Medicaid, or even a marketplace-qualified health plan approach, it’s really about how can I get somebody to do a behavior in a more immediate fashion instead of waiting many weeks achieve success. We’ve seen these programs work very well.
Q: How do these solutions help with risk adjustment?
KG: When we think about risk adjustment, and it actually ties into member satisfaction as well, we think: What is the most important thing a member needs to do? A member needs to go to the doctor for their annual wellness visit. For example, let’s say I am a type 1 diabetic. I need to have my doctor chart the fact that I am a type 1 diabetic every year. That’s then submitted to CMS so the health plan can get money to manage me as a type 1 diabetic. Plans want that money sooner rather than later. So if we can influence a member to get their annual wellness visit in the first quarter, then that health plan is in much better shape than if I, as a member, am going later in the year. Just from an overall plan revenue perspective.
Q: We’ve talked a little about members and the benefits for them. Can you share the benefits of member engagement in care guidance?
KG: Any program you put in place—care guidance or not—is never a set it and forget it. You will never be successful if you say, “I have this great solution for you, but I’m just going to assume you’re going to participate.” For example, I love Peloton. If I forget I love Peloton, Peloton reminds me every single day how much I love it. I get emails telling me exactly what previous classes I might have taken, what I like, what I didn’t like. They’re trying to influence how much I use the machine. And the reason why they want to do that is because I pay them on a monthly basis, and they don’t want me to leave. They don’t want me to sell my Peloton.
So when we think about member engagement as part of a care guidance perspective, we think about the frequency and the way we communicate with members. And it really has to be on the level of each person. We all have different communication preferences. It’s really a matter of, if I’m going to engage with members, I need to think about all the ways I can communicate with members. Every year we have to evaluate that engagement strategy.
Q: How do we transition consumers from being more reactive in their health to being more proactive?
KG: By helping clarify the information and the ask of the member. In many cases, the way that we communicate with the member is dictated to us—either because the health plan has rules and regulations around words we can use, or CMS has those rules.
But if we don’t talk to people in real-world terms that helps them understand why it’s important for them to go to the doctor, they’re going to get annoyed and never respond. So I think it’s on us as an industry to start changing the way we talk to members and consumers and use data to proactively identify risk before risk happens.
Q: Is there anything else you’d like to share or talk about?
KG: I love thinking about member engagement and how we guide members to get appropriate care. We want to align as much of our strategy to the same tools that have been working for over 30 years. We also need to consider AI and how we can use technology to influence behavior. At the end of the day, the member behavior we’re influencing drives back to value.
