Foundational elements to a fantastic member experience

Clinically integrated networks (CINs) leverage provider organizations to provide a seamless, convenient experience

January 5, 2021

Wei-Lin Huang, LICSW, MAS-PHM | Member Engagement Manager

A member's desire to connect with their doctor through digital technology was on the rise before the COVID-19 pandemic.2 Since the pandemic began, the demand for a digital option to interact with doctors steadily increased, and now it is an expected service to no one's surprise. A recent HIMSS survey found that patients of all demographics prefer having frequent, convenient avenues to communicate with their healthcare providers.1 In another survey with over 1,000 respondents in the United States aged 18-55+, the vast majority (85%) are interested in services that enable them to find and schedule appointments with appropriate healthcare providers.4

With the growing demand for digital solutions that expand and augment the communication streams and member engagement approach, it is important to understand the following:  

  • Patient experience and member engagement definition
  • Three core concepts for reaching members and increasing healthcare engagement 
  • How clinically integrated networks like Embright support these trends 

Defining patient experience and member engagement 

What is patient experience?  

Before understanding member engagement and preferred communication methodologies that increase member engagement, it is important to define “patient experience”. Although a universal definition for patient experience does not exist, some core components of patient experience include:3  

Crosses the continuum of care - Patient experience is not limited to one episode of care or one visit to the primary care doctor. The entire patient experience includes all the patient touchpoints, such as selecting which doctor to see and receiving their bill.  

Expectations and perceptions – Patients interact with their doctors and the healthcare system through the lens of their personal preconceptions of healthcare and past experiences with the healthcare ecosystem. It is always important to be aware that patients come with their own expectations that may influence their experience.

Individualized and personalized – Although it is valuable to standardize processes and deliver evidence-based medicine when possible, personalizing the care provided and how patients would like to interact with the healthcare ecosystem positively impacts the overall patient experience.  

Bottom line: Patients value a seamless and personalized care experience that enables them to communicate efficiently and feel heard by doctors.3

What is member engagement?  

The focus on member engagement in healthcare has steadily increased over the recent years, with 80% of payers noting that as one of their top investment priorities to increase member enrollment and retention.7 Expanding on patient experience, member experience and engagement considers a more comprehensive member journey and touchpoints that they experience across the larger healthcare ecosystem, from selecting their health plan to paying a doctor bill.   

The goal of member engagement is to meet members where they are and empower them to engage with the healthcare ecosystem. 

Three core components for increasing member engagement  

1. Omnichannel 

Omnichannel member engagement strategies utilize multiple touchpoints in a comprehensive and concerted communication approach to appear “seamless, simple, and comprehensive” to the members.6 The omnichannel approach empowers members to select how, when, and where they interact with their doctors and access necessary health-related information. Although a majority of members still prefer calling a contact center to schedule appointments or ask about their benefits, member portals and apps offer members more convenient access with the 24/7 self-service model.5

2. Personalized and relevant 

Personalized, relevant outreach strategies improve overall member engagement and satisfaction in healthcare.5 Members are wary of general messages that do not resonate with them. Organizations and members may have differing opinions of what personalized communication and engagement strategies may look like, therefore it is imperative to deeply understand your member population, their communication preferences, and communication style. 

3. Preserving a human connection

Preserving a human connection with members is still valuable. Although the allure of transitioning completely toward automated, digital means of communication is tempting, most members still prefer speaking with a human, either by phone, text, or online chat (6). Care navigators can provide that personalized, human connection as they listen to and assist members with their unique needs.5

How clinically integrated networks like Embright can help  

Clinically integrated networks (CINs) like Embright leverage the expertise and inherent commitment of the provider organizations within the network to deliver a seamless, coordinated healthcare experience to their members. Unlike point solutions, doctor appointments and other services are integrated and available to the care team. This integration empowers the providers, specialists, health guides, and care management teams to work together to provide the best experience holistically - from service rendered to the bill received. When health systems and provider groups participate in a CIN like Embright, they commit to this level of service and integration of care. This unique aspect provides the member with a unified, seamless, and coordinated healthcare experience. 

Embright crafted an omnichannel approach to support the seamless and convenient experience members desire today. Members have access to our one-stop shop member engagement experience and app that allows them to:  

  • Perform self-service activities such as looking up their healthcare coverage benefits and employer partner benefits (e.g., Employee Assistance Program)  
  • Connect with a live care navigator (what we call “health guides”) for that personalized, human touch  
  • Discover providers, specialists, clinics, and hospitals in-network

There is no silver bullet or single solution when it comes to perfecting the member experience, but there are several foundational elements if implemented with a clinically integrated network that can tip the scales towards success.

1 - Patient communication preferences in 2021 [PDF]. 

2 - Patient preferences for using technology in communication about symptoms post hospital discharge. 

3 - Reexamining “defining patient experience”: The human experience in healthcare. 

4 - What member engagement means to today’s healthcare consumers. 

5 - Top 3 member engagement benefits of using omnichannel tools. 

6 - Digital member experience services may boost plan satisfaction. 

7 - Payers, providers, patients provide unique perspectives regarding consumer engagement investments and effectiveness.