How health care consumer engagement can boost employee satisfaction, reduce costs

Commentary: You’ve invested in point solutions, transparency tools and narrow networks. You’ve held education sessions, offered mobile apps, online tools and resources. Yet your employees still aren’t engaging with these programs as expected or as the vendors promised.

Why isn’t it working?

Viewing employees as health care consumers, developing a keener understanding of how they experience their health care and following five core principles of engagement will help turn the tide.

The transition

No one chooses to be a health care consumer. Unlike shopping for a new TV or computer, experiences done on the consumer’s terms, shopping for health care comes at a time when their life has been disrupted by an injury, illness or a bad diagnosis, often times leaving them vulnerable and not functioning at their best.

Even if the illness isn’t complex, the experience is. A Center for Advancing Health study showed that consumers have to make 41 major decisions at one time when faced with a health care issue.[1] These decisions run the gamut from what’s covered under their plan to the life implications of their illness. Discussions with physicians, specialists and even their carrier are often had in terms that are unfamiliar, jargon-filled and intimidating.

It is no wonder patients are overwhelmed and confused. Research shows that 50% report leaving the physician’s office not understanding what they were told by the physician[2]. In addition, 41% of patients self-refer to a specialist, and 61% of such referrals will be to the wrong physician, resulting in a delay in receiving the treatment they need and a 33% higher cost of care as a result of the “rule out approach."[3]

When you consider that the average health care journey lasts 11 months, and a consumer will see five to seven different providers and have 25-50 claims filed on their behalf, it’s easy to see why intercepting this process at the very beginning, and seamlessly providing the information, support and resources consumers and providers need to make the right health care decisions the first time is critical.

Engagement matters

As we all know, engagement drives improved outcomes, employee satisfaction and lower health care costs. Without it, the intended results are impossible.

Earning trust is central to building patient engagement, yet not everyone can earn it. For instance, consumers give carriers, their primary source of care information, a Net Promoter Score of -20, as compared to a consumer health care navigation companies’ score of +60 (NPS is a measure of consumer loyalty.)

So how is trust earned?

A simple question, “am I covered?” opens a window into the journey that is just beginning to unfold. Engaging the patient, and their provider, in an ongoing, meaningful and personally relevant conversation about their health care needs builds the foundation of trust. Becoming their ally, advocate and sticking with them, from that very first call to when their very last claim is paid, solidifies it.

Engagement produces results. It increases the likelihood of the consumer staying in-network and following evidence-based guidelines, reducing the chances of an unnecessary ER visit or hospitalization. When providers are engaged, redundancies, errors and wastefulness can be eliminated and appropriate care at an appropriate cost delivered.

5 engagement principles

Consumer engagement is the magic interaction that everyone is striving for yet for most remains elusive. Helping your employees fully engage – as an educated health care consumer – begins by following these key steps:  

1. Recognize that employees are unprepared to go it alone. Employees want to make the correct health care decisions, both with respect to care and cost. But they are bewildered, scared and overwhelmed by the decisions they have to make. They need access to immediate expertise and someone who will stay with them along the way.

2. Make it easy by centralizing the process. Offer one point of contact, one phone number, one app through which they get information, support and access to care they need, eliminating the need for them to search on their own.

3. Partner with an organization that consumers trust. A relationship built on trust will heighten their engagement, leading to better outcomes and improved costs. But trust is earned; make sure that consumers know that there are no competing agendas and the people they are talking to are there just for them.

4. Coordinate care and have authority to act. Helping all the patients’ providers know what care is underway and what the patient is or isn’t doing helps ensure the most efficient care. Handoffs to third parties, even with the best of intentions, will continue to fragment the system and frustrate the plan members.

5. Stick with them. Be there when the healthcare journey begins and stay with them through the process. Help them understand what will happen next, prepare, relieve their fears and get them on the right path will lead to savings and improved outcomes.

Deb Gold is senior vice president of market strategy and consultant relations with Quantum Health. She has spent more than 30 years in executive positions in top health care companies, including as a senior partner at Mercer Consulting, a partner at Towers Perrin, and leadership positions at United Healthcare and CorSolutions.