The Importance of Active Member Engagement in Reducing Costs and Improving Outcomes

Cost-effective, quality healthcare is intensely personal and involves a high level of trust between the member and the provider. When individuals engage with their caregivers and other healthcare professionals on a personal level, they build a foundation for holistic care management and better outcomes.

Employers incur an estimated $575 billion in expenses annually due to their employees’ poor health.

The challenge today, however, is that members have numerous options regarding where to get their care, making personalized, holistic engagement difficult. They may use an urgent care center for a sprained ankle, a pharmacy for an immunization, an ENT for an allergy, a telehealth service for a bladder infection, and a retail clinic for a cold. Having these options may provide convenience for members, but it also drives care fragmentation that leads to poorer outcomes and higher costs.

The best way to mitigate this fragmentation is to engage members in a way that helps them become better utilizers of their healthcare benefits. This requires finding ways to guide them toward becoming more informed participants in their care journey. Doing so can lower medical costs by 5.3% and reduce hospital admissions by 12.5%.1

What is an Actively Engaged Member?


An actively engaged member is one who understands their healthcare benefits from both a cost and utilization perspective. They realize the tradeoff that happens when choosing a plan with a lower monthly premium, but that comes with higher out-of-pocket costs throughout the year. They also possess a high level of health literacy, which is “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”2 High health literacy is essential for proper utilization and optimal outcomes.

The question for employers is how to ensure their members are appropriately engaged with their benefits plan. The answer is to create an effective, holistic engagement strategy. The following is a list of elements that should be included for an optimally performing program.

Customized to the Member: In a holistic model, members are considered unique individuals with unique needs rather than a set of conditions to be treated with a defined protocol. As part of a holistic model, members receive personalized attention to define synergies between protocols to achieve the best, most appropriate outcomes.

Personal Health Nurses (PHNs): Members, especially those with chronic conditions, require ongoing care and continuous monitoring of their condition(s). Personal health nurses—registered nurses with diverse clinical experience—are the perfect conduit for this care. PHNs provide continuous monitoring, medication management, and guidance for managing conditions. The results include a better quality of life for the member and lower costs for all.

Proactive Interventions: One of the most significant benefits of incorporating PHNs into a member engagement program is their ability to proactively identify potential health issues or concerns. With timely intervention, PHNs can prevent minor issues from escalating into significant health problems.

Sustainable Behavioral Change: Poor outcomes are often the result of unhealthy behaviors and poor lifestyle choices. A holistic engagement model focuses on guiding individuals toward healthier habits and sustained behavioral change. This requires addressing the psychological and emotional aspects of making lifestyle adjustments. This whole-person approach increases the likelihood of long-term success.

Includes Social Determinants of Health (SDOH): Health outcomes are influenced by non-medical factors as well as medical ones. Socioeconomic status, education, and access to healthy food are just a few examples. A holistic approach to engagement identifies each member’s potential SDOH and addresses them by providing targeted support and access to relevant resources.

Preventive Care: A holistic member engagement program encourages individuals to prioritize preventive care, get regular check-ups, and seek early interventions when a problem arises. By fostering a sense of accountability for their own healthcare, members are more likely to engage in activities that prevent serious health issues down the line.

Putting it All Together

Employers incur an estimated $575 billion in expenses annually due to their employees’ poor health.3 They’ve seen the number of employees spending $100,000 a year increase by 50% in recent years.4 In these financially challenging times, employers must do all they can to remove barriers and optimize utilization among their members. Implementing a holistic engagement program is a great place to start.

References

  1. https://www.healthaffairs.org/do/10.1377/hpb20130214.898775/
  2. https://www.cdc.gov/healthliteracy/learn/index.html
  3. https://www.healthleadersmedia.com/finance/employees-poor-health-cost-employers-575b-2019
  4. https://www.beckershospitalreview.com/finance/less-than-5-of-us-population-accounts-for-50-of-healthcare-spending-study.html
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