Overcome 4 Internal Challenges with Quality Relationship Management™

Achieving success has never been harder for health plans. The metrics for a high-performance plan have changed rapidly, and teams are forced to deliver better member outcomes with dwindling resources. At the same time, divides continue to deepen between member data, outreach and analytics across health plan departments, making it more difficult to provide a cohesive healthcare experience. Overcoming these roadblocks requires a centralized solution for building member trust and improving engagement.

What is QRM?

QRM is the answer to healthcare fragmentation. The complexities and demands of healthcare force plan staff to rely on costly point solutions and focus attention on time-consuming roadblocks that prevent meaningful engagement, including:

• Disparate data: Data lives across multiple vendors, departments and spreadsheets, making it difficult to understand members.
• Duplicative outreach: Members receive uncoordinated outreach from various departments, causing abrasion, increasing costs and hindering positive health outcomes.
• Lack of scalable personalization: Understanding members, their wants, their needs and their barriers to get them to respond appropriately is challenging.
• Operational limitations: Significant industry change makes it difficult to remain regulatory compliant and contributes to staffing challenges such as budget cuts and employee burnout.

Designed to reduce this fragmentation and eliminate these roadblocks, QRM is an integrated engagement platform that brings together member engagement, surveying and analysis under one location. Supported by a HITRUST CSF® certified infrastructure, QRM equips health plans with the appropriate tools and strategies for building member trust through four key pillars:

QRM enables health plans to engage their members at crucial moments by consolidating member data, coordinating outreach, creating personalized experiences and streamlining internal operations.

Consolidate Member Data

Healthcare data is divided across multiple data silos that prevent teams from capturing complete views of members. Accessing this data often requires downloading files from multiple platforms and manually stitching them together while distracting staff from focusing on work that matters. But without this compiled data, teams cannot fully understand member needs and develop meaningful, data-driven interventions.

QRM centralizes data into longitudinal member records and regularly updated dashboards to set the stage for data-driven engagement strategies. The platform uses basic enrollment information to start building member profiles and leverages comprehensive surveys to close critical member data gaps, including:

• Risk and quality gaps
• Social determinants of health (SDOH)
• Primary care provider and care team
• Member experiences and sentiment
• Contact information
• Preferred communication channels and languages

By integrating with strategic partners, QRM further enriches engagement strategies by deploying outreach based on 360-degree views of members. Each touchpoint is automatically recorded in QRM to continuously expand member records. Through this comprehensive data, teams can know exactly where to focus resources to improve member engagement, satisfaction and loyalty.

Coordinate Omnichannel Outreach

Members need clear, direct messaging to navigate their healthcare journeys, but a lack of coordination between departments and vendors creates abrasive experiences that delays timely care. Receiving duplicate or conflicting messages from different teams makes members feel like their plan does not understand their needs. Plans that fail to communicate in preferred languages or channels, for example, risk alienating members, resulting in low trust, poor health outcomes and costly, ineffective outreach.

Discover how QRM uses coordinated, digital-first outreach to reduce operational expenses by 7x when you download a cost-savings analysis.

QRM brings all member touchpoints, interactions and outreach into a single engagement control tower to help teams conduct smarter, data-driven outreach. Campaigns are tracked across easy-to-use dashboards that showcase what messages members have received, what activities they have completed and what barriers to care they are currently facing. Through these insights, teams can coordinate outreach to deliver the right message at the right time in the right way to improve health outcomes and member satisfaction.

For example, quality and risk teams may have different end goals for members, but they both need to get members into primary care provider (PCP) offices to close care gaps. Rather than conducting separate Annual Wellness Visits (AWV) campaigns, QRM enables these teams to conduct a single campaign to achieve the same outcome and give both teams access to the data.

This approach shifts plans from a transactional relationship to a transformative one where members receive continuous, relevant messages at the right moments to drive health outcomes.

Personalize Engagement at Scale

Manually customizing each message at the member-level is costly, time-consuming, but generalized outreach also limits each messages’ ability to engage members. To personalize engagement at scale, plans need both an in-depth understanding of members and the ability to action that data in meaningful ways.

By bridging the gap between data and outreach, QRM continuously tailors communications and personalizes experiences at a member-level. Every data point is funneled back into longitudinal records to build a 360-degree view of members and inform future outreach strategies. Teams can use these data points to filter member populations into targeted outreach lists and quickly personalize each messages’ content to match members’ needs, including:

• Health conditions
• SDOH
• Race and ethnicity
• Language preferences
• Response history
• Motivations
• Rewards
• Lifestyle habits

QRM uses a feedback loop that cycles between capturing new data and refining outreach to continuously drive personalization.

Improve Operational Efficiency Amidst Industry Change

The industry is constantly evolving with new regulations, compliance requirements and market shifts that plans have struggled to stay ahead of. With budgets tightening and teams shrinking, maintaining efficiency amidst these changes has become harder than ever. To address operational challenges, plans need to equip teams with the right tools, resources and insights to help them perform more efficiently while reducing reliance on ineffective point solutions.

QRM optimizes budgets, daily tasks and strategies to enable teams to quickly respond to an ever-changing marketplace.

Working from a centralized platform ensures teams no longer need to manually break down data silos or compile complex spreadsheets to access member data. All information is available in one place from a single login. This data is instantly aligned with digital-first, omnichannel outreach capabilities to enable teams to reduce lag time between analytics and interventions. Over time, QRM eliminates the need for disparate, costly point solutions by closing gaps in data, outreach and analytics.

Alongside the platform’s technology capabilities, QRM empowers teams with guidance from industry experts. Complex and evolving regulations are made digestible with insights from QRM’s Expert Advisory Services who have first-hand experience leading 5-Star health plans. Each consultant is backed by decades of experience and specifically selected to meet each plans’ unique needs.

Teams can also partner with content strategists and behavioral scientists to help them determine the best way to engage members. These experts handle the task of planning and designing outreach campaigns so that health plan staff can focus on other priorities. Every strategy is custom built to address specific goals.

Address Immediate and Long-Term Challenges with QRM

Just as the industry continues to evolve with new challenges, QRM evolves to fit your plan’s needs. Teams can start with targeted solutions that solve time-sensitive challenges while scaling up to organization-wide improvements. Healthmine works one-on-one with health plan partners to help them stay ahead of new regulations while ensuring they have the tools they need to handle day-to-day tasks.

See first-hand how QRM empowers health plans to engage members at crucial moments. Contact us for a demo.