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Improving the Patient Experience: Solving the Top Four Healthcare Challenges 

Patients are currently going through a transformation in the healthcare system. They are less like the patients we’ve always known them to be and are starting to act more like consumers. And what is the primary trait of a consumer? Choice.

Patients today are fully fledged, active participants in their own healthcare and are making choices between different services and providers the way they make choices between brands. This changing dynamic requires that the healthcare system makes that shift right along with them. The goal of physicians, health systems, and accountable care organizations should be to ensure the patient’s experience is personalized, relevant, and on par with what they have come to expect from consumer experiences in all areas of their life. There are, however, some common challenges that we see healthcare organizations grappling with while moving toward this new normal, which can only be solved with the right mix of expertise and technology. But they can be solved for—with the result being a more valuable patient experience and relationship.

HealthCare is Challenging 

It is. And these challenges are pervasive across many organizations we work with. We’re talking about gaps in Data, Technology Capabilities, Engagement Strategy, and Organizational Alignment. 

Let’s dive into each one.

Data Gaps 

Do you have the right cell phone number? Do you know if the number you have is even for a cell phone? Is it a land line instead? Do you have the correct contact preferences? Do you have information on their social determinants of health (SDoH) and the barriers to care they’re facing? This data can make all the difference when outreaching to patients and attempting to drive them to a specific action. How can you reach out to someone if you don’t have the right number? How can you affect someone’s behavior if you don’t understand their circumstances?

Solving for Data Gaps 

In all aspects of your outreach, you need to be data driven. This starts with the ability to collect and harness your data. An SDoH Index like mPulse Mobile has is the kind of data that allows you to tailor conversations to a person’s circumstances. Specific capabilities, such as two-way automated conversations, allows us to understand what people are doing and why they’re doing it. By being able to ask people directly and receive an answer, we can take that information, record it as data, and do analysis on it to identify trends. The most valuable insights you can have will come directly from your patients themselves. Of course, this can only be done at scale with the right technology.

Watch the on-demand webinar to hear about outcomes from healthcare organizations who have found the solutions »

Technology Capability Gaps 

Having all the data in the world is little help if you don’t have the technology to use it at scale. You might be deploying one way messaging programs, which means you aren’t collecting information back from your patients to help personalize the conversation and further improve your interactions with themand forget trying to do this on a 1:1 basis without the ability for your technology to automate these conversations.

Solving for Technology Capability Gaps 

Conversational AI and Natural Language Understanding are two important foundational capabilities that can help close this gap. Conversational AI ensures you can tailor your conversation to the individual you’re speaking with, making it more likely you’ll connect with them and drive the desired action. With National language understanding, we can communicate with patients in a way that feels familiar, conversational, and natural. You get at the intent of what your patient is saying and account for humanness (such as typos or slang). At mPulse, we have linguists and computer programmers on staff who work together to come up with scripting that can interpret different combinations of languages, typos, and slang to get to the intention.

Gaps in Engagement Strategy 

Maybe you do have the means to connect with your patients with two-way automated conversations. But are you saying the right things? Are your engagements tailored and optimized to ensure maximum outcomes? How often are you messaging? What’s the tone? Do you have a team dedicated to refining all these different aspects of your strategy?

Solving for Gaps in Engagement Strategy

When you understand how people think and make decisions, you can craft your outreach in a way that predicts their response and uses that prediction to nudge them in the direction you’d like. This is the reasoning behind the behavioral science techniques we bake into our solutions. Humans are fairly predictable, and we mostly react the same. Let’s use that predictability to push them toward healthy behaviors! Many behavioral science techniques are used to build our programs: cognitive overload could determine the pacing of our program; authority bias may dictate who we have giving the information; and storytelling effect could dictations how we give the information;

Don’t know what these behavioral science techniques are? Watch our on-demand behavioral science webinar series to learn how they can transform your engagement strategy! »

Gaps in Organizational Alignment 

Your patient has gotten your messaging, they’ve made the appointment. Now, are you guiding them through transition of care in the most effective way possible? For example, ensuring they’re scheduling an appointment with a PCP after an ER visit.

Solving for Gaps in Organizational Alignment 

The goal is to produce trust-building patient experiences consistent across the entire experience with a brand. For this, we have enterprise engagement, which allows us to handle the scale necessary for organizations which can have 100,000+ patients.

We need experiences consistent across that member base while also personalized to match each individual’s needs. That’s a tall order. And this comes back full circle to data and technologyboth are needed to ensure this patient experience is protected.

The New Normal

Digital trends are changing the game. Patient expectations are changing the game. The choices they have and the experiences in everyday life they’ve grown used to are creating new rules of the road in healthcare. As it should. We have technology in the market today that allows these experiences to be exceptional, so why should they (and we) settle for anything less? 

The Return to Normal: Medicaid Redetermination Edition

By the time the end of March rolls around, we will have seen just over 1,100 days of continuous Medicaid and CHIP enrollment. Federal guidance within the 2023 Consolidated Appropriations Act effectively decoupled continuous enrollment provisions from the Public Health Emergency (PHE) and will allow states to resume their redetermination process as soon as April 1st. 

Most states and many plans have already completed the first phase of the unwinding by encouraging enrollees to update their contact information to ensure they receive their renewal paperwork when it arrives in the mail. And while most all of us reading this piece are well aware of where we’ve been over the last year and what the next one might look like, a recent Urban Institute study in December 2022 found 6 in 10 adults in Medicaid-enrolled families were not aware of an upcoming return to the regular Medicaid renewal process.

You’re probably thinking, “How is this possible? It’s all we’ve been talking about and planning for months and months!” Well, maybe we shouldn’t be so surprised. Medicaid/CHIP enrollment increased by 20 million individuals since February 2020 accounting for nearly 30% of all covered lives. That’s 20 million individuals who likely have never completed a traditional or pre-pandemic redetermination and three years since the last time everyone else has. Lest we forget a lot has changed and occurred over the last three years in general.

Stats and surprises aside, we still have a long road ahead of us and a lot of work to do. Thankfully our regulatory friends like CMS and the FCC have stepped up to help keep individuals from slipping through the cracks. CMS has provided a strategic toolkit calling for states and plans to work together in timely sharing of enrollment data and contact information, for states to expedite content approvals or provide pre-approved language for member outreach, and for enhanced processes for moving individuals who no longer qualify for state-based programs to marketplace offerings. The FCC’s recent declaratory ruling that clearly states the provision of a phone number on an enrollment form constitutes as express consent allowing federal and state agencies and their partners to make Medicaid enrollment calls and send text messages without violating call or text prohibitions. Plans should take full advantage of the resources provided to them by incorporating each toolkit and clarified regulation into their overall member engagement strategy.

Learn more about outreach strategies for the end of continuous enrollment by viewing our redetermination webinar series featuring Kaiser Permanente and Mostly Medicaid »

Key Engagement Factors for the Return of Redetermination

Now let’s talk engagement strategy. Most plans will be using CMS or state-approved content and timelines are tight, so there may not be as much room for the creativity we see when dealing with other engagement topics like closing gaps in care or encouraging timely rx refills. That doesn’t mean, however, that you can’t still take a strategic approach in areas where you can still have an impact, such as channels, personalization, and branding. 

Channels: We know one single communication channel isn’t going to be enough, and it’s just not how people are consuming information or connecting to resources. Adult Medicaid beneficiary smartphone or tablet ownership rates are similar to the general US adult population, and 47.4% of dually eligible Medicare beneficiaries report using the internet to get information. An effective and successful engagement strategy is delivered through multiple channels by combining digital outreach like SMS and email with traditional modes of communication like mail and phone calls. mPulse is currently working with over 30 Managed Care Organizations across more than 20 states within different phases of their redetermination efforts to support engagement on all channels and channel combinations.

Personalization: After selecting your channels, be sure the messages you are sending are personalized and relevant to the member. Even if you are using pre-approved language for your redetermination outreach, make sure your salutation and any other merged fields are in the proper case and not all caps. Even an Excel novice can easily convert cells in all caps to proper case by applying a =PROPER formula to your selected cells. Proper case is easy, but what about language preferences? Reaching your Limited English Proficient (LEP) members can be difficult, especially when you don’t know who they are or what their preferred language is. For example, mPulse technology allows for you to go beyond typical language challenges or compliance required taglines by automatically transitioning between English and Spanish in our two-way SMS conversations.

Branding: Brand awareness and recognition leads to trust. You want your members to automatically know who all messages are coming from so they will not only trust it but also complete the desired request or action. Consider other communications that may be coming from your organization around the same time and coordinate your naming conventions to maximize brand awareness. Help get your brand on the right side of the inbox or in their known contacts by encouraging your members to store your phone number or SMS short code on their device or enhance those efforts by deploying mPulse Virtual Contact File (VCF) messages. 

The New Normal for Medicaid

The return to normal, or rather the return to the new normal is here, and there is no slowing it down. This is still uncharted territory with a lot of work yet to be done, but if we have learned one thing here today, it is that working together, maximizing resources, and leveraging technology to provide a personalized member experience will be the key to successful redetermination efforts.

For more insights into how to deliver this experience to your medicaid population, visit our Medicaid Redetermination Resource Hub or view our on-demand webinar series for Redetermination.

Activating Healthcare Consumer Behavior Change: Make it Personal

Key takeaways from our interview with Solome Tibebu

In the last decade, behavioral health has grown from an ancillary service offering to a critical component of health services and care delivery. According to an OPEN MINDS Market Intelligence Report, spending on mental health services totaled $225 billion in 2019, up 52% from 2009. Companies like Talkspace and BetterHelp, founded in 2012 and 2013, recognized this spike and made it their mission to increase the availability and accessibility of mental health services to those struggling to access and navigate care. Behavioral health has continued to evolve, and it is incumbent on all healthcare organizations to adopt new methods of providing care to vulnerable populations. Learning from innovative companies and forward-thinking leaders is vital to building an effective care strategy for the one in five U.S. adults living with a mental illness.  

mPulse sat down with Solome Tibebu, a pioneer in behavioral health technology and innovation, whose passion stems from the care gaps that have existed and still remain in mental healthcare. At the early age of 16 years old, Tibebu started a non-profit online resource, Anxiety in Teens, to offer education and support for teens and young adults who were struggling with anxiety and depression. After ten years, she began working in startups and consulting, continuing to advocate for the role of technology in advancing behavioral healthcare. 

This year in June, Tibebu will be putting on her third annual Going Digital: Behavioral Health Tech summit, a conference where health plans, providers, health systems, employers, investors and startups convene to discuss the evolving landscape of behavioral health. The virtual (for now) event is a great opportunity to share best practices for implementing digital resources and innovative technologies to improve access to mental health services. We are proud to be a sponsor for the second consecutive year, and we look forward to contributing to discussions around how healthcare organizations can implement solutions to tackle barriers and make mental healthcare more accessible for all.

Improving Access through Technology Innovation

COVID-19 created an array of challenges to advancing mental health access, but it also sparked a digital transformation that brought innovation to the center stage. With more consumers staying home, “tech has exploded as a response to the pandemic,” Tibebu prefaces. Technology plays an important role in understanding and addressing the social dynamics that affect each person living with mental illness. Some of the challenges that plague mental health accessibility require more than simple one-way consumer interactions, however. 

Talking about health plans, Tibebu emphasizes, “stigma is a huge barrier even after they’ve procured some kind of solution, so they need to have a strategy around how they’re gonna address stigma, and engagement of the member.” Stigma can produce feelings of worthlessness and lead to social isolation while social determinants of health (SDOH) like transportation access or income level can prevent consumers from seeking care. To tackle barriers like SDOH and stigma, it is necessary to utilize technology to understand consumer needs and preferences. 

Conversational AI and Natural Language Understanding power the capability to deploy behavioral science strategies at scale when communicating with vulnerable populations. For instance, incorporating a strategy like Affect ensures that messaging is based in empathy, increasing motivation to engage with sensitive healthcare outreach. Social Proof is an effective strategy that helps assure consumers that they are not alone and can help reduce social isolation caused by mental health stigma.  

Applying behavioral science and identifying SDOH in conversational outreach enables a deeper understanding of consumers. Once individual preferences are captured, healthcare organizations can efficiently tailor relevant content to each consumer and activate meaningful behavior change. 

Delivering Tailored Content at Scale

Incorporating clinically validated behavior change techniques helps with understanding the needs and preferences of consumers. Tibebu asks, “now all of these payers have implemented their telehealth solution but it’s the next level – how do we get something more customized, personalized to their respective populations?”  

Plans and providers can drive deeper engagement and self-efficacy by adopting tailored engagement strategies that lift utilization of the programs they’ve invested in. Conversational AI enables the orchestration of programs and resource delivery across preferred consumer channels. Natural Language Understanding helps capture important data from consumer responses to help route them to the appropriate digital resource. 

A one-size-fits-all care model fails to meet the needs of each consumer, while customization empowers healthcare organizations to intervene with meaningful content that drives behavior change. “How can you identify the consumer’s need and triage them to the right end solution?” Tibebu reiterates. Certain individuals who prefer a visual learning experience may benefit from a course like Living with Anxiety & Depression, while those who respond better to audio can be directed to a podcast like Mental Health Matters. 

Providing on-demand, curated content can motivate consumers to take control of their health and execute healthier behaviors, leading to improved outcomes and a better consumer experience.

Impacting Beyond Mental Health

We asked Tibebu why personalization in mental healthcare should be important to payers specifically. She responded, “because mental health is at the vortex of all health…for all of these other conditions, expensive conditions, that are impacted as a result of poor mental health.” Consumers who are negatively affected by mental health are more likely to develop chronic conditions, which piles up costs for both the consumer and the organization providing services. This creates an opportunity for plans and providers to adopt innovative solutions that promote well-being through tailored engagement. 

MagellanRx Management serves a complex population and recognized the need to incorporate well-being content for their members who were experiencing loneliness and anxiety from COVID-19. They partnered with mPulse to deploy digital fotonovelas, which use culturally sensitive stories in a comic-strip format to improve health education and activate diverse populations. The program drove impressive outcomes, yielding over a 38% engagement rate and a 90% member satisfaction score. 

We questioned how organizations outside of payers and providers can “step up” to make mental healthcare more accessible. Walmart Wellness is a nationally recognized brand whose goal is to “help customers raise their hand and more easily access their hubs,” Tibebu clarifies. Walmart partnered with mPulse to implement SMS solutions along with streaming health education to drive their customers to the right well-being resources. The program included custom learning plans across several wellness topics and produced significant improvements in customer engagement. 

After chatting with Tibebu, we are reassured that mental healthcare should be the focal point of an effective engagement strategy. Innovative companies can promote mental well-being and health literacy by leveraging technology that personalizes outreach. Educating consumers with tailored content through timely and convenient engagement builds self-efficacy and lasting behavior change.

Learn more about Conversational AI and streaming health education here. 

 

Key Takeaways from RISE West and the mPulse Mobile Roundtable

During the RISE West conference earlier this month, there were a lot of conversations about the changes that face healthcare in the new year. 2020 brought on a lot of changes to CAHPS measures and weighting that will not only affect the new year, but transform the way Medicare plans will be evaluated and rewarded for the foreseeable future. mPulse Mobile focused on 4 strategies to prepare for 4X CAHPS ratings during our roundtable at RISE West, and it fell in line with what the conference presented overall. Here are our takeaways from the event both the roundtable and the conference.

Focus on Creating a Relationship

Plans will need to keep up with the changing quality guidelines, including the change of CAHPs survey scores to 4x weighting. Everyone knows running a successful Stars program has always been more of a marathon than a sprint. Plans do everything they can to improve member experience and health outcomes on a daily basis, year over year, in an effort to maintain and attain high performing status. It comes as no surprise, COVID 19 has thrown a wrench in those plans and now the marathon has become a decathlon – hurdles around each corner, new sprints to the finish, jumping over and through an ever changing regulatory landscape while throwing everything you have left at anything you can hit.

What’s interesting about these changes are how plans will have less focus on traditional priorities as they are weighted differently. The opportunity here is to think beyond traditional HEDIS and medication adherence improvement strategies and deploy solutions that will engage members in a way that builds a rapport between member and plan or provider.

Creating new touchpoints with members where they can respond and feel heard is critical. mPulse uses automated “check-in’s” and follow ups after customer service interactions to create scalable conversations with members. By listening to member responses and answering back, we both gather key data and give members a chance to have 2-way interaction with their plan on their terms.

In the roundtable, we noted that all of those best laid plans for 2021 Stars don’t have to fail or be seen as all for naught. Even though CMS has recycled last year’s CAHPS and HEDIS rates for 2021 Stars, the hard work and efforts put in over the last few years are likely still improving member experience and health outcomes, it just won’t be displayed as such on Medicare Plan Finder.

Be Proactive

Engaging members about their experience with their plan via automated message helps gather necessary data to respond to the member, but also provides an opportunity and touchpoint to share good news about plan changes. Sharing new information that may affect the way the member interacts with their plan will build trust and help further establish that onboarding process that will lay the groundwork for future conversations. A proactive approach around potentially negative news or changes helps eliminate surprises for members who may not be otherwise aware of a formulary change until they get to a pharmacy.

Act on the Experience Data You Have

2021’s changes require MA plans to listen to what members are saying more than ever before: the good, the bad, and the in-between. Taking stock of every member touchpoint and the data it generates is key to tailoring communication with the member. And while plans usually think of experience information as call center or appeal/grievance data, virtually any information the plan has can be used to create a meaningful interaction or make an existing one more impactful. Just member date of birth and date of joining the plan create opportunities for birthday reminders, health plan anniversaries, or milestones and shows that the plan is interested in the member. mPulse takes member responses to surveys or automated outreach and applies sentiment and intent analysis. This takes a strong initial data point and enriches it so that the plan can see, for instance, how members respond to gaps in care outreach, as well as those who are consistently negative or positive in their interactions with the plan. And by building personas around trends in experience data, plans can better predict “look-alikes” who may be more likely to have a neutral or negative opinion of the plan but have not filed a grievance or complaint.

Understand the Member Experience Impact of Telehealth

Plans can implement CAHPS improvement strategies and customer service operations to optimize member experience around digital care. The last six months have essentially forced beneficiaries, carriers, and providers to embrace innovations and technology. Now there is a need to improve member experience with digital and remote care and how its value is communicated to members. Plans who engage and support their membership through this new and ever evolving space will come out on top. It takes more than just letting a member know they have coverage for telehealth visits, it takes an extra effort to educate and encourage them. Creating interactions where members can share barriers, hesitations or concerns with telehealth will be key to an effective CAHPS strategy in 2021.

Plan for a Second Wave of COVID-19 and Strategies to Close Gaps in the Meantime

It is difficult to predict the lingering impact of COVID-19 in late 2020 and early next year. However, when plans begin to shift towards post-COVID strategies, they will need to remain agile and ready to accommodate shifts in public health guidance and CMS rules. In general, plans should not wait to encourage members to complete key preventive care visits and screenings if possible and stay adherent with medications. Knowing that more changes from CMS are coming, plans should continue both maximizing their performance now, and putting processes in place to be successful when Stars returns to “normal” and COVID-19 rule changes no longer protect ratings.

Plans who make an effort to build stronger connections with members and execute a deeper CAHPS strategy now will be more likely to see a successful Stars season in 2022. Since better relationships with members do not necessarily reset every measurement year, it’s also the area where plans can see the most value for their quality improvement efforts now.

The Challenges and Opportunity for Technology and Health Equity

We know that COVID-19 has amplified many underlying issues in healthcare and beyond. Health equity was already an important topic in healthcare, but COVID-19 has brought it into sharp focus as cases, hospitalizations, and deaths from the virus disproportionately impact disadvantaged groupsTechnology use in delivering healthcare is another long-time trend catalyzed by the pandemic, as millions were left with virtual care as their only option for the first time. Iseems apparent that these advances in technology use create the capacity to meet people where they are with information and care that is quickly and easily accessible. But it will take careful effort and consideration to ensure that access is improved for those that most need it in an inequitable system. And with new technology, there will also come new challenges and barriers that may not have existed in the past. 

Understanding Technology Across Segments 

At mPulse, we naturally look closely at technology adoption rates in healthcare’s most important populations. When we look at the disparities in technology use and access, they tend to line up with the negative outcomes we see in healthcare. Black and Hispanic communities have faced a disproportionately higher fatality rate than other races due to COVID-19 and suffer from higher rates of chronic conditions. The Pew Internet Research Center’s statistics show black and Hispanic communities more than twice as likely to be dependent on smart phones for internet access than white Americans. This means that they are more likely to rely on smartphones as their sole access to the internet, as opposed to a tablet, laptop, or desktop computer. Telehealth platforms that are optimized for desktop/laptop use and not mobile phones could disadvantage these groups disproportionately. Furthermore, populations who may not have access to stable and high-speed broadband in their homes would only be able to interact with telehealth that is mobile-optimized and can be supported on a cellular data connection 

Though smartphone dependency and internet access disproportionately impact minorities and low-income groups, mobile phone adoption presents an opportunity to connect hard-to-reach populations with tools and information to access and maintain their healthcare. Overall cellphone adoption rates in the US have converged across demographics, with Black, Hispanic, and white Americans equally likely to own a cellphone (over 96% of all adults do). So while internet and broadband-reliant technology may create new barriers hat must be overcome if telehealth is to become a long-term solution for improving access, engagement solutions that focus on cellphones have the potential to reach oft-neglected populations just as effectively as any other 

The role technology can plan to help address health disparities will be a key area covered by our keynote speaker – Dr. Gail Christopher- at our Activate 2020 virtual conference. Dr Christopher is the Chair of the Trust for America’s Health. 

Language Barriers: A New Version of Old Challenges

Telehealth and virtual care in general must be able to support multicultural and multilingual populations effectively. According to a poll from the Associated Press-NORC Center for Public Affairs Research, “half of these Hispanic adults age 18 and older rely on family or another health care provider to help resolve language or cultural difficulties in the health care system, while more than a quarter have relied on a translator, public resources in their community, or online sources for assistance. Understanding that language barriers in traditional care delivery may have been managed more than successfully bridged will be vital as systems and plans roll out new models. Beyond language, there can be significant cultural differences in attitudes and use of the healthcare system across populations.  mPulse has seen in cases with several multi-cultural populations that tailoring content to account for language as well as culture can be just as important as tailoring based off of health status or age. In cases like the COVID-19 pandemic, where organizations need their entire populations to understand important prevention and system navigation information, closing gaps between language and cultural groups becomes critical. Configurable and engaging content that can be fully adapted to different languages or populations, such as the fotonovelas we’ve used with some of our customers are just one example of the effort required to get key information to people in these diverse populations equitably.    

Preconceived Notions of Telehealth 

Studies have shown Black and Hispanic communities may feel more uncomfortable interacting with health professionals via camera and having facial pictures taken – practices that are common in telehealth appointments. This discomfort could be a factor for low engagement, or appointment no-shows. So while these two communities are likely to be among the most at risk for negative health outcomes, if they do not feel comfortable engaging with their plan in the new virtual or telehealth environment, they may be a lot less likely to move forward or seek out careBuilding trust becomes crucial. One of the advantages to the kinds of asynchronous and automated conversations that the mPulse platform supports is that the patient or member can engage on their own time and terms. Whether through solutions like ours, or other types of outreach, organizations should find opportunities to create meaningful touchpoints with the people they care for that do not initially require new technology navigation, app downloads, or unfamiliar forms of interaction. In fact, some of our leading plan partners have used mPulse as the primary means of driving awareness and adoption of their telehealth platforms. The key has been that members who are used to getting important and relevant engagement from our solutions about their benefits, medications, and preventive care, are being directed to telehealth by an established and trusted line of communication with their plan. Helping to meet members at their comfort level and introduce new technology with compassion and understanding will be vital to ensuring the widest access.  

How can healthcare achieve the triple aim of managing cost, access and quality of care when it comes to virtual care and other new technologies? How can we embrace connected health and the power of the Internet of Things when smart device use is not embraced or even feasible across all populations? And how can technology create opportunities to solve disparities and inequities in healthcare? These questions will take a central role as we move toward an end of the pandemic and the healthcare system reckons with its long-term impact on how we deliver healthcare in the US. And while we can’t always expect definitive answers, being aware of challenges and watching for opportunities is the first step to making that impact as positive as humanly possible.

5 Key Takeaways from Speaking at the 11th Annual Medicare Market Innovations Forum

On Thursday, July 16th, 2020 our VP of Marketing, Brendan McClure, Bill Jenson from Independent Health Care, Linda Roman, and Brenda Mamber from Cenaturi Health, spoke at the 11th Annual Medicare Market Innovation Forum. BrendanBillBrenda, and Linda explored designing unique member experience and how leveraging data can build loyalty. 

Here are our 5 Key Takeaways:

 

1. THE PANDEMIC HAS CHANGED MEMBER ENGAGEMENT AND MEDICARE PLANS ARE ADAPTING 

 Bill and Brendan both noted that the COVID-19 pandemic has accelerated a number of existing trends in member engagement. Telehealth access outreach, check-ins with members about their wellbeing, and conversational engagement to both inform and uncover insights all took on much greater importance. For plans where these member-centric touchpoints and engagement procedures were already in place, the trust between member and plan was greater once the crisis started. Early COVID engagement strategies from the plans already engaging conversationally have given plans a unique advantage to build even deeper connections with membersBrendan gave a real example where an automated check-in with a Medicare population prompted a response from one member who said that he had not heard from anyone in two weeks and deeply appreciated the care and concern from the plan.  

 

 2.  CREATE A UNIQUE MEMBER EXPERIENCE BY ASKING THE RIGHT QUESTIONS 

When a plan can ask the right questions and supply the proper resourcesmembers are more likely to engage and leave the conversation feeling heard. Plans often have underutilized resources and interventions due to a lack of member awareness, or because plans do not know who needs what. But simply asking members in conversational channels if they are experiencing issues like social isolation or food insecurity both create the opportunity to connect them with resources and identify members who may need follow-up. By asking the right questions, a plan can uncover barriers to action such as transportation, health literacy, language, and the like. Asking and then providing the member with the appropriate resources will not only drive engagement and drive behavioral change, it will help build the trust needed to engage in future conversations. 

 

  3. LONG TERM ENGAGEMENT BUILDS TRUST AND LOYALTY 

Loyalty is a product of building trust. A member is more likely to engage in future conversations when they feel like the plan is invested in their health as much as they are. Brendan noted that trust comes from a plan who communicates accurately, timely and quickly. In addition to the example of COVID-19 outreach from plans that were already having conversations with members regularlythe panel noted how important building trust over time was when it came to SDOH barriers. Members are more likely to share barriers and more likely to accept help and interventions when there’s trust in an established relationship. The stronger that relationship, the more confident a plan can be in retaining that member over time, and counting on them to engage in the future. 

 

4. ENGAGEMENT IS A BRAND DIFFERENTIATOR FOR AGE-IN 

 Because trust is established during ongoing conversations over an extended period of time, when a member is ready to transition into Medicare they are more likely to accept information and resources from their planThat level of trust will keep members open and willing to communicate with their plan on a regular cadencemPulse has found that members who received text outreach from their plan previously about health or services were much more likely to request information on their payer’s Medicare plan options via text. Leaning on the trust built throughout the relationship to continue to ask questions about their experiences with their healthcare and using that data from past conversations with the member to tailor age-in outreach can be a winning combination for both retention and member experience. 

 

5. MEASURE THE MEMBER RELATIONSHIP  

Brendan reminded the audience that the data you get from engagement depends on the questions you askThere is value in all variations of member responses. Discovering whether a member is happy or unsatisfied with their plan creates the opportunity to tailor further engagementSentiment and intent analysis of member responses to automated outreach provides valuable feedback to the planAsking member directly how they feel about their plan, or measuring positive and negative responses to questions about their health or the COVID-19 pandemicgives plans insight on retention risks, hotspot geographies that may have provider network issues, or topics where members seem to be dissatisfied. Uncovering these potential blind spots and quantifying members’ expressed feelings toward their plan gives payers actionable data to impact everything from future engagement strategies to benefit design.

5 Key Takeaways from Speaking at Rise National

mPulse Mobile’s CEO, Chris Nicholson, spoke alongside Rex Wallace at RISE national on the Engaging Hard-To-Reach Members to Drive Action Around Quality and Risk speaking session. Chris and Rex explored how to define hard to reach Medicare members, the importance of trust in engagement, some proven strategies and results, and how the new weight on Star Measures will impact how plans think about these populations.

Here are our 5 key takeaways:  

1. UNDERSTAND WHAT MAKES MEMBERS HARD-TO-REACH  

Members who do not engage or act after multiple outreach attempts tend to face several factors that make building a connection more difficult. Sometimes the issue is a matter of access to the content or channel. Language or cultural barriers can severely limit engagement with English-only outreach, and members who rely solely on smartphones for internet access can be much harder to reach via email and web portals. Our research shows that lower engagement tends to correlate with higher impact from Social Determinants of Health (SDOH). That impact can take many forms, from housing insecurity which causes mail to be delivered to old addresses, to lower overall health literacy that makes one-size-fits-all reminders to close care gaps less meaningfulBut the area that Chris and Rex explored the most was the members who simply did not trust their plan 

2. TRUST IS CRITICAL 

Data from Oliver Wyman suggests that trust is vital when members consider taking action on their health. A 2017 study that Chris and Rex discussed in the session shows that consumers are just as likely to consult with friends and family on whether to seek medical care as they are to ask a provider. And they were less than half as likely to check with their health plan. The difference is the level of trust and strength of relationship. Plans have an opportunity to build trust in their outreach by making it more conversational and tailored to the member.  

3. DESIGN PROGRAMS TO BUILD A RELATIONSHIP WHILE DRIVING THE OUTCOME 

 Asking members questions – Why haven’t you visited the doctor? Why didn’t you refill your prescription last month? – and listening to their responses creates a twofold impact: You build trust by letting the member guide the conversation, while also uncovering barriers to action. Members who identify barriers feel heard and can be connected to plan resources to overcome them like ridesharing, appointment scheduling assistance, or health literacy-building content. And gathering barrier data can give vital insight to your quality improvement strategy.  

4. MEASURE TRUST AND MEMBER EXPERIENCE 

Rex and Chris dove in on how to define and measure trust in a member’s relationship to the plan. They used a four-part definition of trust from the American Psychological Association to explore how plans can measure something so qualitativeFirst, trust is based on past experiences and prior interactions, so plans should take steps to treat engagement as a long-term relationship rather than a series of campaigns and monitor engagement rates over time and across touchpoints. Second, trusted partners are seen as reliable, dependable, and concerned, which makes analyzing the sentiment of member responses to outreach a possible proxy for measuring how members view their plan. Third, trusting parties disclose information to each other and take on risk by relying on the other. This is where measuring and analyzing member responses to questions that ask for them to disclose things like barriers, SDOH impact, or other challenges can help plans understand the level of trust members place in them. Finally trust means confidence and security in the caring responses of a partner – which means members lose trust in plans that ask questions but don’t seem to listen or act on answers. Chris noted that when plans ask a member if transportation is a challenge but don’t correctly understand their answer (or don’t provide a remedy if they say yes), they damage the relationship they were trying to strengthen. 

5. MEMBER EXPERIENCE MEASURES CREATE NEW PRIORITIES FOR HARD-TO-REACH ENGAGEMENT 

Rex noted how the major changes from CMS to emphasize Member Experience and Complaints measures in formulating overall plan Star Ratings are a game changer for MA plans’ engagement strategies. These changes make the importance of each member’s relationship with their plan all the more critical to understand and improve. Previously, outreach focused on driving specific member actions to complete screenings, refill prescriptions or control a chronic condition. CAHPS measures making up over 50% of the 2023 Star Ratings measurement weights will mean that outreach should shift to measuring member experience and coordinating interventions based on their responses. Rex reminded the audience that one of the most important factors in member satisfaction and experience is what happens during provider encounters, which has traditionally been a blind spot for most plans. Chris and Rex said targeted and two-way outreach to gain insight about those blind spots is a great first step to incorporating the new CMS rule into engagement strategies.  

Our Reaction to the Two New TCPA Rulings from the FCC

This past Thursday, June 25, 2020, was a busy day for the Federal Communications Commission (FCC) and their oversight on the Telephone Consumer Protection Act of 1991 (TCPA). That law, and the FCC rules enforcing it, create the primary regulatory structure that guides how automated outreach via phone and text to cell phones lawfully happens in the US. As a result, mPulse is always monitoring FCC rulings, federal court cases, and Congressional actions that relate to how our customers can ensure they are always compliant with the TCPA. So, when the Commission issued two binding Declaratory Rulings relating to the TCPA last week, we knew it was important to examine what was (and wasn’t) changing as a result. Here is our breakdown of the two new rulings. (Note: I’m not a lawyer and this should not be taken as legal advice.) 

P2P Alliance Petition 

What it isThe FCC ruled on a 2018 request from the Peer 2 Peer (P2P) Alliance asking for clarification on what constitutes an “auto-dialer” that calls or texts cell phones. This definition is key to determining if the TCPA applies to a technology platform.  

What happened: The Commission’s Consumer and Government Affairs Bureau (CGB) made two key rulings. First, they clarified that an auto-dialer must store or generate random or sequential phone numbers and call them without human intervention. They specifically clarified that a technology platform where a human had to manually enter each number prior to calling or texting would not be subject to the TCPA, no matter how fast they would be able to call or text. Second, the FCC reiterated a long-standing view that, even when using an auto-dialer subject to the TCPA, calls and texts made to cell phones with the consumer’s prior express consent are permitted. They also took a moment in the ruling to note, “The Commission has repeatedly made clear that persons who knowingly release their telephone numbers for a particular purpose have in effect given their invitation or permission to be called at the number which they have given for that purpose, absent instructions to the contrary.” They finished by saying that if P2P was an auto-dialer, but was only calling or texting consumers who had provided their cell phone numbers to the calling parties, those calls/texts would be permissible because they were made with prior express consent. 

What it means: Because of our scale and the crucial nature of the calls and texts (among other channels) our platform powers for our healthcare customers, mPulse has always operated under the assumption we fall under the TCPA, even as the definition of an auto-dialer has been debated in federal courts. So, our operations won’t change due to any update to that definition. The reiteration that providing a mobile phone number constitutes prior express consent, absent instructions to the contrary, is a good and clear reinforcement of the FCC’s view of how consumers can opt into non-marketing text and phone outreach.   

Text of ruling: https://www.fcc.gov/document/cgb-issues-declaratory-ruling-p2p-alliance-petition  

Anthem Petition 

 What is it: The CGB also ruled on a 2015 request from Anthem that was asking for an expansion of the exemptions for healthcare messaging under the TCPA. Specifically, Anthem asked for the FCC to rule that calls and texts from Anthem (and plans or providers in general) that concern healthcare should not need to have prior express consent as long as consumers have an easy opportunity to opt out. The existence of a prior established relationship between the plan and members is enough, in their argument, to start that outreach. Second, they asked that broader healthcare calls/texts should be exempt from the TCPA entirely because they are welcomed by consumers and represent urgent healthcare concerns. Specifically, Anthem listed calls/texts on subjects like preventive medicine outreach, case management, to “educate members about available services and benefits,” and the use and maintenance of benefits.   

What happened: The Commission declined to grant Anthem’s requests. They emphasized that consent must be obtained prior to starting outreach regardless of an existing relationship, but noted that healthcare callers should have little problem obtaining that consent. The FCC also disagreed with a few of the Anthem petition’s arguments for making a content-based exception to the TCPA for non-emergency healthcare calls and texts.  

What it means: The FCC’s ruling is positive in a number of ways. This was the first time that the FCC directly addressed calls and texts that health plans typically send their members. The FCC’s treatment of Anthem as a healthcare entity – consistent with their definition of a “healthcare provider” as a HIPAA-covered entity and/or their business associates as those terms are defined under HIPAA – helps health plans get clarity that the TCPA protections for healthcare calls and texts – which require prior express consent instead of the prior express written consent that general marketing calls require – apply to their health-related messaging as well as those from hospitals or doctors’ offices. Ultimately the FCC’s move to look at health plan calls and texts and determine that no change was needed gives us confidence in the compliance procedures we have helped our plan customers follow for over a decade.

Text of ruling: https://www.fcc.gov/document/cgb-issues-declaratory-ruling-and-order-anthem-inc

COVID-19 Member Engagement: Our Top 5 Best Practices

Health plans are confronting the COVID-19 outbreak on a wide range of fronts. Member engagement and outreach has become crucial as people want to hear accurate information and access helpful resources from the organizations that manage their care. The rapidly changing nature of the crisis and the massive amount of questions and concerns that members have about it makes this a uniquely difficult communication challenge. As a partner to some of the best and largest plans in the country, mPulse Mobile has been helping our clients face that challenge, sending over 10 million messages about COVID-19 to Americans in the first week after the WHO declared it a pandemic. Three weeks in that figure has grown to over 20 million. As plans and providers grapple with how best to keep members informed while maintaining focus on delivering care and support to the members who most need it, we identified 5 key best practices to help our clients navigate COVID-19 outreach:

Focus on Efficiency

Getting accurate and timely information to your population is a top priority. As the crisis progresses, it becomes difficult to focus on building and maintaining outreach efforts, and “build-your-own” vendor tools can take deceptively long to deploy. Now is not the time to task an IT team with implementing and managing self-service tools or develop content for new channels for the first time. Work with a healthcare-focused partner with existing and ready-to-launch content to help you keep your members aware of resources you have available (e.g. telehealth, mail-order pharmacy, etc) and updates to shelter-in-place and social distancing guidance.

To help organizations launch and optimize programs quickly and confidently, we developed our COVID-19 Strategic Communications toolkit, which has details on our ready-to-launch programs and essential platform capabilities. Click here to learn more.

…But also, Be Strategic

As Covid-19 continues to evolve, it’s critical to plan outreach strategically. The urgency of the situation makes it tempting to send mass communication through emails, mailing, or broadcast phone or text outreach whenever there is new information. We have seen organizations find the most success when they work with us to plan content, channel mix, frequency, readability, and language. You want to be a consistent, trusted, and an easily accessible resource for members – that means being careful to not over-message or use channels with limited reach and engagement, or use content that is not optimized for your audience or outreach method. Strategically thinking about the way you deliver those messages will not only drive critical resources to members efficiently, it will also build a stronger long-term line of communication as conditions shift.

Help Your Staff Through Automation

Call centers are heavily impacted during this time. We have heard from clients that members are calling into nurse lines and member services centers with COVID-19-related questions at an extremely high rate. Help throttle inbound calls by leveraging the automated outreach that gets general information and self-service resources into members’ hands before they call. Proactively sending members links to telehealth options, online resources, and symptom checkers, (the CDC has one if you don’t yet https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html) will help members with COVID-related questions without calling in for additional questions.

Be Ready for Members’ Responses

Because of its unmatched reach and read rates, using SMS is an obvious best practice in crisis situations. But the conversational nature of the text channel combined with the uncertainty and dynamism of this crisis means that you need to be prepared for members to reply back with questions or concerns. In the initial weeks of the pandemic, we have seen even 1-way text campaigns that do not solicit any response receiving high levels of replies from members. Generic autoresponders that ask members to call a number for help can cause member abrasion and more inbound calls at a time when you want to avoid them (see #3). At minimum, you should ensure that member responses to COVID-19 messaging receive relevant auto-responses.

mPulse has gone a step further and developed a Natural Language Understanding domain around COVID-19. This domain reads and automatically categorizes non-standard responses so that members get questions answered and concerns addressed. It dynamically updates as members reply to outreach, so programs will get better at understanding member replies over time.

Support your entire population

While broadcast messages out to your members are fast and easy, it’s crucial to ensure your strategy accounts for differences across your members to ensure ongoing outreach is relevant and effective going forward. Utilizing zip code segmentation allows for content to be tailored to members in specific areas, allowing for updates on specific facilities, services, or public health guidance. We have also seen plans using fotonovelas to reach multicultural segments of the population. They use comic-style graphics that help break down language barriers and can be utilized during COVID-19 to showcase best practices, resources, and updated information.

The COVID-19 crisis has placed tremendous pressure on the healthcare system, including how it communicates to the populations it cares for. With these practices, plans can get the right information out to the right people efficiently and effectively. For more help, email info@mpulsemobile.com Review our COVID-19 Strategic Communications toolkit, where you can find details on multiple COVID-19 programs. Click here to access the toolkit.

Improving Patient Engagement in Pharmacy Operations Using Conversational AI

Leading healthcare organizations from payers to IDNs, PBMs, specialty pharmacies, and hubs have recognized traditional programs for patient engagement are proving ineffective. Mail, telephonic and even app-based tools are not how the modern consumer prefers to communicate. Many consumers have experience engaging with ChatBots and Conversational Agents through automated conversations, and they are demonstrating a preference for this dialogue-based approach. Engaging with companies through messaging conversations is convenient, self-service tools delivered this way are more efficient and communications are tailored and relevant. A recent large cross-industry study found that 69% of consumers consider chatbots the preferred way to engage with businesses for quick answers to simple questions. The shift to conversational approaches for engaging consumers is also aligned to the widespread adoption of mobile phones. Mobile phone ownership is at 90% or above across all key population segments, including lower-income adults and seniors over the age 65.

What does this shift in how consumers prefer to engage mean for pharmacies?

The pharmacy industry is adapting to the rapid increase in specialty medications. These therapies have more complex dosing regimens, a higher potential for side-effects and require closer patient monitoring as a result. The generally higher costs of these medications also make demonstrating improved health outcomes and value critical. To ensure patients are successful, pharmacies must provide high-touch clinical support and they have large teams of support staff based in call centers to check-in, follow-up and assist with patients. But this becomes challenging when consumers are much more reluctant to answer telephone calls. Which is why conversational texting represents a huge opportunity for specialty pharmacies who want to maintain their high-touch approach, deliver it efficiently at scale, and leverage a consumer-preferred channel.

Leading pharmacy organizations have identified this opportunity and are leveraging conversational text messaging approaches to:

  • Improve chronic condition medication refill rates by 14PPs
  • Increase the number of touchpoints during therapy dosing period by over 3x
  • Reduce the average call wait time from 8 minutes to 90 seconds by diverting calls to the text channel

Click here to learn more about these outcomes and how Conversational AI programs improve patient outcomes in the pharmacy space.