How to Drive Benefit Use & Protect Patient Health in the COVID Era

The COVID-19 pandemic has not only made health insurance a more urgent concern for business and HR leaders, but also focused their attention on digital health benefits that went largely unused before the pandemic.

In April, 43.5% of Medicare members used telehealth services — up from 0.1% in February. It's safe to say the percentages would be similar among group and individual plan members — especially after many group plans waived cost-sharing for telehealth visits during spring lockdowns.

Most plans have been offering telehealth and other digital services, for years now. COVID simply made members more aware of the benefits, and helped anyone who had qualms about receiving care virtually to get over them.

Whether they had qualms or not, most of them apparently liked that they saw: more than a quarter of American workers now say they'd be willing to leave their jobs for a company that offers digital health benefits.

From basic tools like telehealth to innovative new apps that use digital therapeutics to help manage chronic pain, digital benefits have often gone largely unused for a variety of reasons. The biggest obstacle was health plans' inexperience in communication directly with their members.

That's partly because employers did most of the communicating, but neither plans nor HR departments have historically been very effective at letting members know what benefits were available or how to use them.

By improving that communication, health plans can take advantage of COVID-19's disruption to drive up benefit utilization — and to drive sales and retention as business and HR leaders look closely at not only what digital tools are included in their plans, but at how they can encourage their employees to manage their health safely, and at a lower cost, during the pandemic and beyond.

The plans that can reach the right members at the right times through the right channels will have the greatest success at increasing utilization — and at gaining and protecting market share.

Right Members, Right Time, Right Channels

Most plans today offer at least a basic set of digital benefits — telehealth, wearables, provider searches and the like. Many also offer more sophisticated tools like online nurse chats, concierge services that help navigate the system and healthcare knowledge bases that offer more curated, trustworthy health information than a Google search.

And plans have begun to partner with technology companies to offer innovative services like Ginger, which provides behavioral health support, or Kiio, a digital program that helps manage lower back pain.

The way to get a member to use these tools is to by alerting her to their availability when the member is most likely to need them. A member searching for a chiropractor should receive an alert — by email, text or app notification, based on her preferences — telling her that her benefits include Kiio. Then, with a single click or tap on her phone screen, she should be taken to Kiio or the appropriate page on the plan's website.

The COVID crisis provided a real-time demonstration of the value of those kind of communications — urgent updates like waived copays or new telehealth options had a far greater impact for plans that were able to inform members of those changes quickly and effectively.

Plans that have the technology to define cohorts of members based on demographics, then sequence the appropriate messaging in minutes, not weeks or months, will be able to deliver effective, timely communications that reach members where they want to be reached, when the messages are most relevant. Those plans will see higher benefit utilization rates — and safer, happier members as a result.

Making Member Experience Pay Off

Just as COVID has heightened the need for effective push communications, the pandemic has made it vitally important for plans to offer digital self-service for members who expect to be able to find information and conduct basic transactions on their smart phones and laptops.

Even older consumers increasingly prefer digital transactions over in-person or call-center interactions. By eliminating the in-person option and making call-center wait times interminable, COVID only heightened the need for health plans to offer intuitive, user-friendly member portals and mobile apps, plus chatbots and search tools that help members get the information they need, when they need it, on benefits, providers, costs and other critical decision factors.

The plans that drive up benefit utilization — and with it, member satisfaction and market share — in the COVID environment will likely be the ones that offer the kind of digital experiences consumers have been conditioned to expect by airlines, banks, streaming services, retailers and other businesses.

Health plans can expect member experience to take on greater weight in group purchasing decisions as business leaders seek to give their employees the most modern, effective and efficient means for managing their care.

The good news: in 2018, 81% of payer organizations said they were investing in member experience technology. In the pandemic era, the investments most likely to pay off will be those that enable plans to deliver the messages prompting members to use their benefits in ways that lead to better health outcomes.

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Mark Nathan is the founder and chief executive officer at Zipari, a health insurance consumer experience technology company.