Recently, McKinsey & Company published its paper, "The untapped potential of payer care management." Its subheading summarized the main points of the paper:
Payers have an opportunity to improve ROI on care-management programs while ensuring a healthier experience for members, especially when considering increased needs from the COVID-19 pandemic.
McKinsey & Company proposed a definition of care management that involves any payer-driven efforts to engage with targeted members and their care ecosystems to encourage and enable high-value decisions. This extends beyond nurses connecting with members over the phone to manage a condition, such as diabetes, or to prevent an acute event, such as readmission. McKinsey & Company offers four next-generation actions that payers may consider to potentially improve the ROI of care-management programs, while also ensuring a better, healthier experience for members:
1) Targeting multiple high-potential sources of value
2) Right-sizing care-management
3) Engaging members in ways that consumer companies do
4) Running care management with an operational mindset
Importantly, care management can help close care gaps and improve Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance, as well as improve performance on Medicare Stars, potentially leading to a more patient-oriented approach and to additional direct premium dollars through Stars quality bonus payments.
This article will focus on McKinsey & Company's third next-generation action, Engaging members in ways that consumer companies do, because this is what differentiates PatientBond from other patient/member engagement technologies.
Engage Members as a Consumer Company Does
The paper points out that, "Payers may better engage members by improving data sets to identify more potential members, enhance member contact information and leverage multiple channels to reach members, consider psychographic segmentation approaches to engage more members and consider an 'engagement first' approach to more successfully support member behavior change."
Emphasis was added to the statement regarding psychographic segmentation because PatientBond uses a proprietary psychographic segmentation model in its member engagement platform that has been proven to motivate and activate member behavior change.
Psychographics pertain to people's attitudes, beliefs, values and personalities, and are core to their motivations, priorities and communication preferences. PatientBond identified five distinct psychographic segments, each with unique approaches to health, wellness and healthcare, and each requiring unique engagement strategies to influence their decisions and motivate behaviors:
Self Achievers: This is the most proactive and wellness-oriented segment, driven by goals, measures and progress toward health enhancement. While Self Achievers may have a chronic condition, they are driven to stay ahead of it.
Balance Seekers: This psychographic segment is also wellness-oriented and engages in healthy nutrition and an active lifestyle; however, they are highly independent and self-reliant and may not engage the healthcare system until they must. They want options, choices and context for a provider's recommendations.
Priority Jugglers: Priority Jugglers are reactive in their own healthcare but very proactive for their loved ones, ensuring they receive the care they need. Priority Jugglers may neglect preventive care and screenings for themselves, but they are dedicated to those who count on them.
Direction Takers: This segment wants directive guidance from healthcare professionals and trusts their credibility and credentialing. Direction Takers reason that physicians and other providers are experts and are paid to know the answers. Direction Takers are not prevention-oriented but access the health system frequently.
Willful Endurers: The most reactive segment and often disengaged with health and wellness, Willful Endurers live in the "here and now." They are less likely to address a health issue until they need to but do not like to wait for care; Willful Endurers are the most likely to be frequent visitors to the Emergency Department, urgent care or retail clinics.
PatientBond's psychographic segmentation model was developed by healthcare consumer experts from Procter & Gamble, who led such work for P&G's Healthcare Division since the early 2000s and are now part of PatientBond's Leadership Team. PatientBond's psychographic segmentation model is a 4th generation model evolved from three previous generations at P&G.
PatientBond has spent the past eight years operationalizing the model for payers, hospitals and health systems with remarkable results.
"Segmenting members based on psychographic factors could help payers concentrate outreach on members... more receptive to care management"
- McKinsey & Company
Psychographic Segmentation in Care Management
Advisory Board recently published its care study titled, "How TriHealth Used Member Segmentation to Customize Outreach," in which it detailed how an integrated delivery network in Cincinnati, Ohio, used PatientBond's psychographic segmentation model to drive lifestyle modification with employees and their dependents among regional employers.
Health coaches were trained to engage members using psychographic insights and segment-specific messaging to address health issues such as diabetes, musculoskeletal conditions, weight management, smoking and other opportunities. This psychographic focus did not replace other training and approaches but rather enhanced the health coaches' ability to establish trusting and influential relationships among members.
After TriHealth started using psychographic segmentation, one of their employer organizations saw 83% of their participating members make substantial progress on their health goals. This organization also saw a 28% reduction in at least one risk among participants (e.g., reducing BMI, lowering A1c levels, decreasing blood pressure, etc.). Other results TriHealth has been able to achieve include:
- 27 percent increase in program satisfaction
- $621,000 savings in a single year at a single employer
- 5:1 ROI for participating employers
Digitize and Automate Processes
McKinsey & Company also points out that payers often conduct many care-model processes manually, such as calling members and filling out assessments with known data. The paper recommends making smart investments into multi-channel, digital technology and automation on appropriate tasks to minimize time spent by staff on manual tasks. For example, a payer can automate phone calls through Interactive Voice Response (IVR) technology.
The PatientBond Patient/Member Engagement Platform automates digital outreach through email, SMS/text messages, IVR and in-app/portal messaging. PatientBond truly personalizes member engagement with psychographic segment-specific:
- Keywords and phrases
- Digital channel mix
- Frequency and cadence to maximize receptivity and minimize message fatigue
- Member response mechanisms to facilitate two-way communication (e.g., quick surveys, confirmation of information comprehension, call requests, etc.)
Using psychographic segmentation to inform its multi-channel, digital engagement, PatientBond has delivered outstanding results for its clients:
- Up to 90% reduction in unnecessary hospital readmissions
- Fifty-seven percent increase in response rates to colon cancer screenings
- 4-7X increase in member response rates to mammography and diabetes screening communications
- Ten percent increase in the duration of therapy for specialty pharmacy
As the McKinsey & Company paper points out, there are many opportunities to improve care management processes and deliver much-improved ROI from these efforts. While psychographic segmentation and automated workflows may be relatively new to healthcare, these approaches have been used for decades in the Consumer Industry to great effect. PatientBond is ready to help payers, health systems, hospitals and other providers take advantage of these approaches.