When health plan executives strategize about the wave of retiring baby boomers, they usually focus on the member side and the exploding demand for medical services from an aging baby boomer population. However, this wave also will ripple through the leadership ranks of health plans themselves.
Many plans already are welcoming a new generation of leaders with fresh ideas, particularly when it comes to the role of technology. New leaders are from a younger generation, meaning they likely bring a deeper familiarity with digital tools and openness to emerging technologies. They also are increasingly coming from industries that are ahead of health care when improving users’ digital experience, said Kimberly Swanson, Vice President, Consulting & Professional Services at Healthmine.
New leaders are helping plans to break down the silos that are separating their internal systems and to introduce member-friendly portals and apps that improve a member’s experience with their health plan. Members want to manage all aspects of their health in as few platforms as possible, so health plans that work towards integrating how members pay bills, complete surveys and manage their care will be better off in the long run. Member experience matters more than ever, with Consumer Assessment of Healthcare Providers and Systems (CAHPS) comprising about one-third of overall Star Ratings in Medicare Advantage.
“If you invest in user experience end to end–which includes surveying your members, understanding where they are, assessing whether they have access issues and educating them on how to use their plan benefits and engage in health care–your quality measures will be a reflection of that investment,” Swanson said. “It’s not an ‘either-or,’’ Swanson said, “but an ‘and-also.’”
We’re seeing big changes across the board in how health plan performance is measured by the Centers for Medicare & Medicaid Services (CMS) and at the state level. With a growing emphasis on whole-person care, eliminating health disparities and understanding diverse populations, health plans must look at how they interact with their members.
An Inevitable Shift in Leadership
The generational shift is unavoidable, though the COVID-19 pandemic prompted some health plan executives to retire early or explore other industries. The tail end of the Baby Boom–the generation of people born between 1946 and 1965–will be largely out of the workforce by 2030.
Millennials, defined as those born between 1981 and 1996, have made up a majority of the U.S. workforce since 2016 and became the country’s largest generation overall in 2019. So, it’s no surprise that millennials hold a growing number of leadership roles and are now setting the tone for healthcare.
The historical leadership strategic approach has been focused on maximizing traditional process-based quality measures, such as the numbers of cancer screenings and hospital readmissions. While millennial successors are also focused strong performance in quality measures, they’re open to the many ways tech-based tools can improve the member experience and help facilitate measure improvement on an ongoing basis.
Investments in providing a holistic member experience can help drive improvements in quality measures, since they lead to new ways of engaging members and ensuring they have access to the care and services they need, Swanson said. In addition, member experience is a growing factor in how Star Ratings are calculated in Medicare Advantage.
“The trend of bringing fresh eyes into the plan is really about pushing health plans to modernize to meet the needs and expectations of younger and tech-savvy generations,” Swanson said. “These leaders are digital natives with a high level of comfort to push plans to innovate quickly to offer an end-to-end digital experience and transform traditional and manual member outreach activities to user-friendly and highly utilized digital engagement.”
How Digital Tools Make an Impact
Communication is one of the first places where the shift in emphasis is becoming apparent. Health plans have long communicated with members via traditional means. Thick welcome packets arrive by mail, while phone calls remind members to see their doctors or schedule screenings. Plans often collect feedback, meanwhile, through focus groups and when members call in to customer service, as well as other informal methods.
Health plans have been phasing in newer approaches, a combination of new leaders and new regulations. Traditional tools are being replaced by text-message reminders and regular surveying to gauge member sentiment, Swanson said. And, with an eye on gaining instant feedback on how they’re doing, plans are sending out short surveys to members following visits with their doctors or calls to a customer-service line.
Digital tools also can help health plans understand and act on cultural differences among their members, Swanson said. Plans can provide personalized materials in the languages and communication styles that are most effective based on the recipients. “That wasn't always possible in the past,” Swanson said. “This level of customization is needed to engage the hardest to reach individuals and to meet growing health equity requirements.”
Leveraging new digital tools also allow health plans to quickly discover and address issues facing their members, with potential benefits in a plan’s annual Star Ratings. “The need for more real-time member feedback been a high priority over the two years and continues to be a larger focus,” Swanson said.
In addition, health plans are looking for new ways to increase the satisfaction of members who are neutral and could easily be tipped into being considered dissatisfied. “It’s all about understanding the member, checking in with the member, understanding where they are and closing the feedback loop,” Swanson said.
A Solution that Works
As health plans evaluate the many digital tools at their disposal, they should focus on solutions that will allow for quick adaption in changing regulatory environments.
Healthmine assists Medicare, Medicaid and commercial health plans in focusing on the quality measures that truly impact plan performance by leveraging digital tools for meeting specific measures, identifying gaps and improving member satisfaction. With Healthmine, plans can capture the right information about their members, better understanding their health and healthcare challenges for the right interventions, at the right time and communicated in the right way.
And as health plans embrace new leadership, digitally focused solutions can help facilitate easier internal change. Healthmine helps plans easily identify areas of opportunity. Know exactly which members need support, what their communication preferences are and what type of interventions have the greatest impact. Taking the guesswork out of member management means smooth periods of change.