For Payers, Going Local Means Being Personal and Precise

By Health Ideas Staff
Mar. 25, 2019

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Going Local

Dale, age 43, loves his Bit-O-Honey. But not today.

His first bite ended up ripping out an old filling in one tooth. Time for an immediate trip to the dentist.

Within hours, he was all fixed up. His dentist provided the service and his employer’s health provider did the rest.

This payer has gone local and knew within minutes of Dale’s plight when his dentist scanned his insurance  card. The payer’s quick-response care team sent Dale a text, a reminder to contact his Care Concierge if needed, and to answer questions or confirm coverages. Thereafter, the concierge checked in on Dale’s condition and ensured Dale that he could lean on the care team for additional services. The concierge even scheduled his next appointment to replace the tooth with a crown.

The service was personal. And driven not by the provider but by his payer. Such payer services are emerging as the next stage of consumer-centric care. Payers are seeking ways to better serve their customers and provide personal, localized services.

Align, Engage and Invest: Going Local Means Being Personal

  • ALIGN. Recent trends show us that payers are pursuing partnerships with retailers, social services organizations and a host of different providers to drive closer encounters with healthcare delivery. The goal is to localize and personal services, and do so by combining resources, personnel and technologies into local points-of-presence. It’s all about Alignment, a collaboration that makes it cost effective to initiate, mobilize, sustain and replicate programs and services that are needed—and valued—by consumers. Alignment is a means for payers to offer face-to-face personal care to consumers.
  • ENGAGE. Getting personal requires proactive and persistent engagement that delivers value to consumers. Payers intent on localizing their presence can initiate services that relate to “coverage” and more. For example, it’s common for individuals to not enroll in their health care plans on time, likely because of questions, concerns and fear of the unknown. Payers can initiate local, personal services prior to enrollment periods to educate members on plan benefits and provider network, identify transition of care needs, respond to the FUD (Fear, Uncertainty Doubt) factor and provide overall reassurance. Other engagement strategies can incorporate personalized concierges and quick-response teams that are available via telephone, email, or text—at local sites and events. The spectrum of engagement ranges from online and phone support to being present at local community health fairs and screenings, offering community health education, and even more personal services such as a “virtual assistant” to manage medical appointment reminders and have prescriptions sent to pharmacies and filled.
  • INVEST. Payers pursuing local engagement face the balancing act of managing costs while diving deeper into direct consumer services. Leveraging investments in provider relationships, technologies and data analytics is critical for payers to localize their services. It requires payers to identify and address medical conditions, social determinants, consumer preferences and more. Keeping up with consumers requires payers to apply dynamic, practical and real-time information that requires investment to improve quality and truly engage the local consumer.

Going local magnifies the mission to personalize consumer-centric services that improve quality, cost and clinical outcomes while achieving best-in-class experience. Success comes with effective alignment with key players, engaging consumers with services that extend beyond what’s expected, and then investing in the outreach and support systems.

Going local means being prepared. And precise.

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