4 questions that will help your plan build a Member Advocacy roadmap

What information does your health plan need to build a Member Advocacy roadmap? Jacob Sattelmair, Wellframe’s Executive VP and General Manager, sat down with Jessica DaMassa of WTF Health to discuss Member Advocacy and the future of digital health management.

As a health plan, what jobs do you do for your members? Historically, health insurance companies focused on the provider side of healthcare. Plans built networks, managed risk, set pricing, and implemented care delivery methods. But health plans have a new opportunity: supporting members’ daily health decisions. 

The biggest differences in health outcomes are due to member behavior. Member Advocacy helps health plans address member needs without relying on point solutions.

Health plans and members both benefit when you offer high-value, and convenient care. Invest in individual members, communities, and populations to structurally reduce risk. Plans that can shift to this mentality will have an advantage in an industry that relies on member experience and their perception of value.

More than any other stakeholder, health plans have an aligned incentive with members to help them stay healthy and get the highest-value, most convenient care possible.

Jake Sattelmair

What’s causing the rising emphasis on Member Advocacy?

The first investments in healthcare technologies focused on making health information accessible. This usually meant a patient portal with details about deductibles or in-network providers. 

In other industries, technology can completely replace in-person interactions—but healthcare is different. Member Advocacy shifts engagement to a digital space, but always with a human behind it. This technology may allow providers to discharge members early and monitor them remotely. Or a member might choose a video call follow-up instead of in-person visit.

Technology is not replacing human support: it’s shifting the support channels to be convenient and scalable.

Why should health plans take on the role of Member Advocate?

Advocacy-based care management helps members achieve better outcomes and consume care more intelligently. Seeking healthcare is vulnerable. Care teams have to make sure members feel supported during a stressful time. It’s not just about giving members information. 

At the advent of digital health technologies, popular belief was that only the young and wealthy would use them. But that’s not true today. Members of all ages, incomes, and geographic locations are embracing digital health management. Member Advocacy facilitates proactive outreach and support across clinical contexts.

There’s the risk that, if you’re not investing in a different member experience and new approach to member engagement, then it will put you at a disadvantage.

Jake Sattelmair

Keep your members in mind as you plan your Member Advocacy roadmap. The Member Advocacy infrastructure allows care teams to personalize the member experience. Providers can configure resources and care plans to accommodate a member’s goals. 

Digital engagement gives members more flexibility to access care and resources. Allowing members to reach out while they’re at work or taking care of their families adds more value than telephonic outreach alone. 

What are the consequences of not investing in digital engagement?

Your plan and your members both benefit from high-value, and convenient care. Investing in individuals, communities, and populations can help structurally reduce risk. In a healthcare industry that relies on member experience and perception of value,  Member Advocacy can give you an advantage.

Not investing in member experience puts health plans at a competitive disadvantage. Employer groups and other stakeholders are putting more emphasis on consumer expectations. Health plans are losing out on RFP opportunities because they can’t deliver the right service model or member experience.

Member Advocacy helps extend relationships to meet members’ physical and emotional needs. Digital solutions can surface insights into what members experience in their daily lives. Health plans have a structural advantage that allows them to see members’ complex care issues and curate the right resources. This strategy allows health plans to target members who need the most support.

If you’re able to help more members get higher-value care, you can shift costs across the population and offer a more competitively priced product.

Jake Sattelmair

How can health plans measure the impact of Member Advocacy?

Digital engagement allows plans to receive near real-time feedback on member engagement. Care managers can see if members are answering surveys, reading articles, and clearing reminders. They can use this information to customize their outreach and support.

To build a long-term Member Advocacy roadmap, your health plan can ask additional questions. How does digital engagement translate into clinical outcomes? Which resources are members using? Is there an improvement in care costs and quality? Plans can gather member engagement information and map it to claims data to forecast its impact on key metrics.

Is your health plan ready to embrace Member Advocacy? Download our book, “Shifting your mindset: The 7-part plan to achieve Member Advocacy.”

Readers will learn how to build a Member Advocacy roadmap and execute proven strategies from leading health plans. Plus, get an overview of the entire Member Advocacy process—from implementation to measuring success.