Changing risk model requires new engagement strategies

In the fee-for-service world, the relationship between payers and providers has primarily been transactional. Payers contract providers, providers submit claims, and payers adjudicate and pay those claims. Patients are left to fend for themselves and be their own advocates in a complicated health care system.

By creating a digitally accessible network, one health plan that makes outbound phone calls to close gaps in care for its most at-risk members was able to instantaneously book appointments on behalf of its members. Because call times were reduced (three to five minutes instead of 20 minutes) and by using automated reminders, members were five times more likely to show up for the appointments they needed.

This increase in completion rates resulted in medical cost savings and incentive payouts that benefited both payers and providers. Additionally, the outreach and practice scheduling resources were 400% more efficient than if they had to make three-way phone calls each time a member was engaged.

Patient satisfaction also improved since members were not on hold for extended periods of time, yet had the assurance they were booked with a provider in their network. In a recent Accenture study, 77% of consumers felt that it was important for providers to offer the convenience of online scheduling.

Implementing Digitally Accessible Networks:

· Partnering with payers to identify where risk exists (and what network modifications are needed to mitigate that risk)

· Using analytics to identify appointment capacity and create availability in the network

· Partnering with providers to make the appointments digitally accessible using business rules that put the right patient in the right time slot with the right provider

· Identifying the best engagement strategy to coordinate patient care

· Enabling digital access to those who make appointments (including patients themselves in some cases)

· Enhancing existing processes without creating a disruptive change to operations

Once implemented, robust analytical tools can shed light on how care gets coordinated, the effectiveness and value delivered, and where opportunities exist for improvement and expansion.

Better Way To Engage Patients

As more networks are built using these types of solutions, care coordination will be transformed and patient engagement will improve dramatically. For example, many payers and providers still invest heavily in outbound telephonic solutions to engage patients. But we're rapidly moving toward a world where all phone calls can be replaced by inexpensive e-mail or text message engagement. This gives patients greater convenience and control in booking the care they need. As providers become more comfortable with this type of patient engagement, they can either secure an appointment for a referral on behalf of their patients or let them do it themselves.

As more data gets collected and aggregated, it will be even easier for patients to search and select the services they need. This enabling technology is already commonplace in the airline, restaurant and hotel industries – and is finally making its way into healthcare scheduling. Over time, patients will expect this level of service in healthcare.

By making all healthcare services digitally discoverable, searchable and bookable, all the key stakeholders – payers, providers and patients – can more effectively collaborate and meet the challenges of the risk paradigm. Providers and payers that deploy these solutions will be more likely to attract and retain patients in their networks.

Jason Kressel is Senior Vice President of products and services at MyHealthDirect in Nashville, Tennessee.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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