Kaitlin Howard

By Kaitlin Howard

Kaitlin Howard is a researcher and writer producing insightful content across the healthcare revenue cycle. She has written and produced content for Zelis, Waystar, and Recondo Technology, as well as agencies. With a B.A. in English and Writing from University of Denver, Kaitlin stays current on market updates on claims management and healthcare payments, publishing a regular educational blog series on industry trends and Zelis offerings.

COVID-19 has amplified the need for a massive innovation effort in all businesses alike. A recent systematic review of COVID has driven significant acceleration to the adoption of digital tools leveraged by providers and patients. In fact, according to William Blair’s Consumer-Centric Healthcare: 2022 Update, virtual health usage among baby boomers increased 155%, rising from only 9% pre-pandemic to 23% during.

As such, healthcare payers must look to solve their technology gaps quickly. But that innovation comes with a catch. Organizations must design services and elevate technology with the future in mind.

Let’s look at the data.

According to our 2022 Member Survey, which represents 1100 health plan members, conducted to understand their healthcare behaviors, habits, trust drivers, and priorities for change:

  • 68% of members use digital tools at some point throughout their healthcare journey
  • 22% of members rate transparency and predictability as the most important change that would improve their healthcare experience
  • 47% of members preferred method of communication is digital (e.g. website, app, email)

It’s time to make a move towards a digitized model that meets members at each stage of their healthcare financial journey to drive both member satisfaction and trust.

A Bit of Background

Overall, a lot is going right for members with their healthcare, and, as a result, there is a lot of member satisfaction across the entire care journey. Most members generally feel positive and confident about managing their healthcare.

But there are key touchpoints that are filled with friction and frustration.

Values are shifting. And digital age technology models are growing increasingly out of sync.

Members want to be included in the healthcare decision-making process. Those who feel engaged in their care tend to be healthier and experience better outcomes.

As members continue to shoulder more of the financial responsibility for their medical care, many healthcare leaders are beginning to pay more attention to changing member expectations and looking for scalable ways to deliver on them.

The challenge is not as simple as “there are no tools”. There are a lot of digital healthcare tools for members, providers, and payers. But there’s a difference between offering a tool and launching one that’s highly adopted and seamlessly aligns with a member’s healthcare journey.

Digital Opportunities Throughout the Member Journey

Members of all ages are interested in continuing to use digital tools to help them proactively manage their care. And they want it all in one place.

Organizations can start by implementing post-service digital tools, that:

1. Explain.

“What do I owe (and why)?”

Bottom line: healthcare costs shouldn’t be mysterious.

If members are trying to figure out how much a procedure costs or how to read their benefits, they need a straight answer. And they need it fast.

And currently, many members don’t always feel that’s the case when they reach out for assistance. In fact, some of the lowest-rated points of member satisfaction are understanding costs and trusting organizations to have their best interests at heart.

So what can you do to change all that?

Leverage best in class experiences like simplified EOBs, episode transparency, and health summaries.

2. Verify.

“Is this bill consistent with my EOB? Is it OK to pay?”

As a payer, one of your main goals should be reducing the complexities of managing bills. And the first part of that is encouraging members to wait to pay the first bill until it can be reconciled with their EOBs.

Creating opportunities that consolidate members’ financial needs into one single experience, allowing them to see all of the EOBs and bills, can increase member satisfaction by allowing members gain clarity on the total financial picture related to their care.

Moreover, Bill Review specialists can be used to advise whether members are “OK to pay” their bill. If needed, these specialists may also dispute discrepancies found on behalf of the member.

3. Pay.

How do I pay the bill my way?

Lack of affordability prompts so much anxiety. Costs are rising exponentially. Help members take a breath by communicating alternative financing options.

This could look like ensuring robust engagement with provider partners to set up opportunities to break down payments into payment plans and confirming members know those are available.

Lastly, offering direct access to pay providers from HSA or FSA accounts can help streamline and maximize use of funding accounts and ensure provider partners are paid in a timely and direct manner.

The Wrap Up

Overall, payers need to focus more on the end-to-end member experience, offering the ability to estimate the cost of care, explain costs owed, verify correct payment amount and, of course, pay.

When planning your digital engagement strategy, ask yourself, “What changes do members feel are most important?” Members crave transparency around price and coverage prior to their appointment. They want to feel empowered to find and choose the right provider and plan. They expect modern, efficient digital tools to manage their healthcare and power decision-making.

But most of all, members want an organization they can trust.

To explore more from Zelis on how to digitally empower your members, click here.