Get to Know Health Plan Members

By Cynthia Nustad
May. 31, 2018

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Being a healthcare consumer can be so frustrating.  I don’t know about you, but I’m tired of interfacing with a system that makes me continue to tell my story over and over.  I don’t want a batch of paper forms to fill out on some 1950s clipboard; making each and every interaction feel like it’s the first time the healthcare provider has ever seen me or my family, and in most cases, it is not

Why can’t we start conversations like we do at our favorite coffee shop, or gym or social group?  Hey Cynthia, great to see you today, can I get you your usual coffee beverage?  Hey Cynthia, I see you kicked everyone’s tail on the Fitbit metrics this week, way to go!

Given the importance of healthcare in our lives, our interfaces should be more familiar, more personalized and more satisfying.  I want to walk into an appointment and find that they have my whole history — my medical professionals, recent prescriptions, etc.  Every provider should want to have access to the medical histories of their patients that may be scattered about so that they can deliver more effective care.  And health plans should actually know the health history and context of their members before they call to suggest care that members may not need or miss something that they do need.

The healthcare industry should strive to make each interaction count and make it positively memorable versus frustrating. Case in point, a recent interaction to pick up some medication for my child turned into more than an hour of wasted time.  The pharmacy mis-keyed the prescription, didn’t call the doctor to clarify and waited until a parent arrived to attempt a fix.  Well, they eventually fixed the simple human error that should have been automated to begin with. And once the entry error was corrected, I was asked to get back in line until they again called my name.  Right, you all hear me and have been there, but here is what kicked my hide –they called my name just a few minutes later only to have me wait in line another 20 minutes to pay and pick it up.  Think about how much waste is in the system waiting, clarifying, fixing, asking questions and the like.  The act of just picking up a prescription should not be more time consuming than booking a vacation, applying for a loan or paying your monthly bills. It does not have to be this primitive.

The data exists to understand and craft a health profile that can anticipate the needs of myself and my family and help initiate the right type of care at the right time. The abundant waste in the system could be greatly reduced with better information flow, bringing more efficiency to our healthcare interactions. These improved interactions are bound to result in improved health outcomes, lower costs and more satisfied consumers.  The moral of the story is — know your members and consumers for they are the key to improving the whole healthcare system. We all know we can do better, let’s do it.


Cynthia Nustad is Executive Vice President, Chief Strategy Officer for HMS.

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