The Healthcare Communication Chain Is Broken.

Challenging Times for Patients, Providers and Plans

We are, perhaps, living in the most challenging time for patients, healthcare providers and health plans. COVID surge and increases in the prevalence of chronic disease require care providers, especially those in primary care, to care for a growing number of patients that require increasingly frequent and complex engagement.

A Staffing Crisis

This, in addition to the current voluntary unemployment phenomenon, have created a complex landscape where everybody loses:

  • Patients attempting to contact their care providers face long hold times, often abandoning calls and call-back queues that are ineffective. In essence, patients cannot access care, even in traditionally well-served geographies
  • Care providers are burned out, and many are leaving the professional permanently
  • Those that remain must pick up the slack, relying upon their support team to help ensure patients may access their offices for urgent and routine needs, however;
  • Support staff are leaving their positions in record numbers. Further, high staff turnover means that the new staff require appropriate training to be able to serve the patient community, relying upon existing support staff and at times digital materials to provide this training. Yet stress on the existing team who would provide this training tends to lead to unattended communications channels and uncompassionate communications from an overstretched team who are speaking to a community of increasingly upset and underserved patients

Lifemesh Engage: Solutions for Payers and Providers

Lifemesh Engage provides engagement solutions that reinforce efforts that increase access to care, provide preventive medicine, improve efficiencies, and increase patient satisfaction.

Engage provides solutions to communicate with patients and members across channels, and in an effective and efficient manner that focuses on engagement and proactive care.

For Payers and Providers

Engage was designed to provide tools for Payers and Providers. The broad set of solutions are designed to engage the patient (member) population in a manner that serves both plans and clinicians by engaging with the right individual at the right time, through their preferred method of communication. 

Supporting the overall concepts of preventive care, the Engage solution was developed to combine “Big Data”, advanced analytics (Machine Learning), and Artificial Intelligence (AI) to enhance, enrich, and augment individual and population data to optimize engagement. Furthermore, Engage provides a rich set of tools that provide both inbound and outbound features to facilitate the ideal engagement approach.

For Payers

Payers wish to engage with the right patients at the right time to ensure appropriate care is delivered to their members, and to proactively engage in the next best interaction to enable optimal health. While typically thought of as an outbound-based approach, payers often find their inbound communication methods and processes to be their largest obstacle to patient satisfaction. As such, it is a combination of identification of risk, enhancement of data, and targeted outreach based on health determinants with the additional tools to better engage with members that provide the greatest benefits to both the members and the payer. The right member engagement, at the right time, and through the right channel can provide significant benefits to the payer, but only if the channels of communication support an expedited process for subsequent inbound engagement.

For Providers

In many ways, the need for the providers is perceived to be the antithesis of the payer, in that the provider is less likely to formulate their model on outreach to patients and are more interested in the inbound service they provide that minimizes challenges to engagement, but often done at the exclusion of a formulaic approach to overall care. So, while Engage inbound features are important to providers, this may often be at the expense of a targeted approach to the right message to the right patient at the right time, through the most appropriate method of communication.

As you can see, the challenges faced by both Payers and Providers are in fact the same in many ways, however their focus may diverge. But the toolkit that should be considered is in fact the same, even if the targeted strategy varies.

Inbound & Outbound Engagement

As a result of the above dichotomy, Lifemesh designed a set of tools that can address each unique strategy, and further support the unique needs to support care through patient engagement; both outbound and inbound. This Patient-Centric approach to care provides the tools to become truly preventive in providing care, to target the underserved, and to ensure more effective and efficient access to care.

Outbound Capabilities

Outbound capabilities for engagement include a wide array of tools designed to ensure effective interactions through email, SMS, mobile notifications, and voice-based services, and enabled by the broader patient journey multi-step configurations. However, the outbound capabilities are further bolstered by the “hypothesis testing” capabilities that allow for highly targeted populations to be engaged based on a wide array of highly targeted outreach strategies. More specifically, the hypothesis testing tool allows for rich cohorts to be developed, and to support both outbound targeted recommendations, but to also track success of each outreach purpose, and to support the improvements to care and cost/benefit of each targeted approach… thus enabling the best care in the most efficient manner.

It is perhaps through this care-efficiency model that Lifemesh provides the greatest value, as cost of care is most often the largest impediment to available services and quality of care.

Inbound Capabilities

Inbound capabilities are optimized to address the needs of the patient-initiated communication. Through such solutions as call-center applications, web components, and shared AI bot capabilities, inbound communications can be handled in the most optimal manner through queues, queue priority, and other features. Average Handle Times are reduced, speed to service increased, and access to care optimized. Combined with a cross-channel patient profile, unique rules and optimized communication handling can be achieved, thus allowing for improved access to care, patient satisfaction, and continuous improvement to care. Related to the above concept of care-efficiency, a 360-degree approach to engagement ensures the best possible approach to engagement.

Conclusion

While the needs and motivation may be different for payers and providers, a shared approach can ensure the most beneficial outcomes to care. While payers and providers may have differing approaches and strategies, they both aspire to improve outcomes while reducing costs. In the case of payers focused on Medicare Plus plans, the motivation may be in identifying risk scores and the determinants of risk, while for ACOs it may be on continuous engagement that maximizes care quality of service, all roads converge in terms of patient engagement, and preventive health measures. Engage is designed to meet these goals.