The Key to Care Improvement for Health Insurance | Binary Fountain

July 23, 2020

The Key to Care Improvement for Health Insurance Companies

By: Erik Fessler

care-improvement-health-insuranceThe Triple Aim of Health Care is helping a variety of organizations realize healthcare improvement in cost, quality, and patient satisfaction, including health insurance companies.

The Triple Aim is already thought of as a powerful framework to understand the key drivers in a healthcare system, both with individual providers and hospitals. However, it could also be used by insurers to find new ways to provide members with better healthcare at reduced costs. For many insurers, the key to applying the Triple Aim goes beyond their typical analysis of cost and quality data, requiring payers to collect, understand, and act on patient experience feedback.

In this post, we cover the patient experience component of the Triple Aim. You’ll see what measuring and quantifying patient experience could look like for insurance companies. We’ll also show you how decisions based on patient experience could lower healthcare costs, elevate member satisfaction, and facilitate care improvement for members of health insurance companies.

The Triple Aim of Healthcare and Patient Experience

The goal of the Triple Aim of Healthcare is to improve healthcare by simultaneously pursuing three goals:

  1. Reducing per capita costs of health care
  2. Improving the health of populations
  3. Improving the patient experience of care

Today, payers are constantly analyzing claims and other related data to better understand the quality of patient outcomes and cost in order to guide decision making. By facilitating the collection and analysis of patient experience data, healthcare insurers will be better equipped to improve outcomes and make operational improvements in the spirit of the Triple Aim.

Insurance companies already have cost and value data at their fingertips. They’re using it for everything from day to day operations to long term planning, including network development, and setting reimbursement rates for providers, hospitals, and labs.

Healthcare insurers also have population health data that measures the quality of healthcare outcomes across the patient panel. For example, many payers track everything from preventative measures like Annual Wellness Visits to the episodes like diagnoses and hospital admissions. Thanks to this robust quality data collection, payers can detect health trends within their membership populations and institute wellness programs to prevent the need for future healthcare consumption.

Understanding, quantifying, and streamlining the care journey through patient experience metrics is the final piece of the Triple Aim for payers. With this data, insurers can discover which providers will best serve their members and build the strongest networks for referrals and care coordination.

Additionally, they can utilize patient experience data to improve existing networks by focusing on provider performance. They could reward physicians and staff for positive patient experience outcomes, and ultimately avoid the risk and expense of contracting with lower-quality providers.

What Does a Positive Patient Experience Look Like?

Before payers can analyze patient feedback, they need to define the elements of patient experience. According to research, patients care most about the following components of the experience:

  1. Was the exam thorough?
  2. Did the provider spend an appropriate amount of time with the patient?
  3. Could the provider effectively answer all of their questions?
  4. Did the provider have a positive attitude and bedside manner?
  5. Was the patient included in the decisions around next steps?
  6. Did the patient experience the outcomes they expected?
  7. Did the provider provide clarity around the care plan and give them the appropriate instructions?
  8. Would the patient return to this provider to seek care?
  9. How was the doctor’s follow-up after the exam?
  10. What was the patient’s overall feedback and prevailing sentiment after seeing this provider?

Payers can use these 10 patient experience categories to analyze feedback about each provider. Subsequently, they can share insights and trends with their networks of providers, staff, and internal to help guide better patient experiences.

Insurance companies can use net promoter scores (NPS) to analyze each site of service in their network and even each health plan they offer. Additional metrics and scores could be collected, based on popular areas of patient concern, such as access, wait times, timely return of test results, elder care, coordination of care, and communication.

Insurers can use scoring to optimize their members’ digital experience and journey. Keeping up with customer feedback could help them optimize their digital front door strategies. It could lead to useful tools such as in-network provider profiles and improvements to the billing experience.

Understanding the Patient Care Journey

A payer’s first step to building their patient experience data is to enhance the way they’re surveying the landscape. In the case of patient experience, this means understanding the patient care journey and patient’s experiences though unstructured feedback.

Patient feedback collection is key to understanding what’s going through patients’ minds. Insurers can utilize two main avenues towards collecting this feedback: online reviews and surveys. Thanks to Natural Language Processing (NLP) technology, both of these sources can be processed and analyzed quickly.

Surveys are a versatile tool for payers to understand the patient experience of providers. Insurers can work with structured survey data from standard industry surveys, such as CAHPS and HOS. In addition, they can go a step further and send out their own customized surveys to members after receiving care. Both options can be processed quickly with deep analytics software.

ebook-patient-experience-surveysA major advantage for insurers willing to create their own surveys is their ability to collect free-text responses. NLP technology makes analyzing free-text responses in seconds by scanning text for sentiment and trends.

Without NLP, multi-choice responses have traditionally been more practical to work with. NLP makes the experience of processing free-text responses similar to that of multi-choice responses. The key difference is that patients aren’t required to select the “closest” answer. Instead, patients can tell you exactly how they feel without compromising, giving the surveyor the opportunity to understand the range of insights from customers in the most unbiased way possible.

Online reviews are an additional yardstick that insurers can use to evaluate providers. They’re publicly available, easily accessible, and highly trusted by consumers. Online reviews can be automatically detected and processed by review management software. Much like with free-text surveys, NLP technology can quickly analyze online feedback and even score these reviews in aggregate.

Insurers can use surveys and online feedback to not only measure the performance of health systems, medical groups, service locations, and also individual providers. In addition, payers can publish both sources of member-generated content on their websites and provide profiles. It makes insurers and their networks more transparent and consumer-friendly.

Quantifying the Care Journey

Once insurers have surveyed the care journey, it’s time to quantify the findings for comparison, analyzation, and benchmarking.

As mentioned in the last section, NLP technology can turn patients’ free-text feedback into quantifiable data points. Payers can use this data to track organizational and provider performance over time. Additionally, you can compare data points between groups and develop benchmarks for future performance.

Wide data collection provides opportunities to analyze data on large populational scales all the way down to small granular views. Insurers could compare and find trends in specialties, within hospital networks, with affiliates of networks, and more.

This data, combined with health data and cost data, could yield powerful results. For instance, payers may discover trends in negative patient experience that result in members deferring care with expensive consequences.

Insurers may discover connections between patients who skip annual wellness visits and primary care physicians with poor bedside manner. They may not pick up or correctly use a prescription due to bad provider communication. Low trust in or loyalty to a provider could result in a member ignoring a recommended referral to a specialist.

Payers can use positive patient experience data to see which providers are successful in-patient engagement. They can measure:

  • The extent to which loyal and long-term doctor-patient relationships lower healthcare costs and boost efficiency.
  • How positive patient experience results in better management of chronic diseases.
  • Compliance with care plans as a result of high-quality patient communication skills.

The goal of this step is to understand why some are achieving better and or more efficient patient outcomes. Insurers need to find gaps between efficacy and effectiveness to sort out who looks good on paper, and who gets results.

Streamlining the Care Journey – Care Improvement Thanks to Health Insurance

The final step in this process is to plan, implement, and measure improvements.

These improvements could range from sharing findings with in-network organizations to utilizing information to narrow networks. Insurers working on new value-based care reimbursement models should implement this data when architecting new payment models and performance contracts. Insurers could even use unstructured patient feedback as a data point and key indicator in order to streamline identify medical fraud and unnecessary treatments.

As improvements take effect, it will be crucial to consistently analyze patient experience over time. Consumer sentiment and trends are always evolving, and member preferences should always be taken into consideration.

Payers need to collect patient experience data to complete their understanding and holistically pursue the Triple Aim. Those payers who do not may have more trouble remaining relevant next to insurers who tackle the challenge of adopting the voice of the patient in their decision making. Applying this data could result in lower costs, better care management, and more satisfied members experiencing care improvement thanks to health insurance companies.

About the Author

Erik Fessler
Marketing Coordinator

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