Five Best Practices for Care Programs for Members
By Jessica Schiller, RN, BSN
Jessica Schiller, RN, BSN is director of clinical programs at Wellframe of Boston, MA.
What if your members had all of the information they need and wanted? Medication regimen, social / lifestyle support, education for their conditions, access to a care manager — all the critical pieces related to their health and care in one place, right at their fingertips?
In many ways, this vision is becoming a reality as digital member engagement has become a high priority focus for care management. A crucial part of sustained engagement is the information that members receive about their health and that care managers utilize to structure interventions. Embracing a modern approach to engagement demands a new paradigm for care programs altogether — designed for members, delivered digitally, and personalized to meet each individual’s needs through digital and human support.
The application of personalized, interactive, member-facing care programs can amplify the medical risk reduction of care management by putting the right information in members’ hands at the right time, in the right format. With this in mind, let’s examine five best practices for care programs for health plan members.
One of the primary frameworks of care management is the care plan. In parallel to the medical record, the care plan is a collection of each member’s health history, diagnoses, problems, goals, and interventions, which evolves over time. Care plans function as decision support tools designed to help care managers structure interventions and methods for member support, typically delivered over the phone.
While they have been effective to date, the transition to member engagement through mobile and digital channels highlights where care plans are deficient: they are only available to the care team. In the booming digital age, members should be allowed to engage with this information directly.
Multi-channel engagement methods present an opportunity to extend part of the care plan directly and digitally to members in a new format adapted for the audience and the channel. We call this new concept a “care program.”
There are five best practices for effective member-facing care programs. These strategies ensure members receive the information they need to stay on track with their health in a way that aligns with their needs. In addition, well-designed member-facing care programs have proven to dramatically increase care team efficiency by saving clinicians valuable time in relaying information to members.
1. Optimize for mobile
- Create short, interactive content
- Stick to 400 words or less for engaging clinical articles
- Hold attention with under-two-minute video stories from peers or tips from their doctor
2. Meet health literacy standards
- Deliver content at the lowest reading level possible for broad accessibility
- Write in short sentences with basic structure and simple words
- Provide definitions for medical terminology
- Break complex concepts into digestible pieces
3. Be holistic
- Support the whole person, not just the chronic condition
- Give members the support they want for lifestyle factors like weight loss, nutrition and Exercise
- Provide information on key areas of health maintenance like emotional health, safe alcoholuse, and pneumococcal vaccinations, which also relate to HEDIS metrics
4. Deliver content over time
- Start with foundational topics and build on them over time
- Begin with must-know information, like what to do in an emergency, the importance of routine follow-ups, and red flags for the member’s condition
- Progress to education on complications associated with their condition, what their medications do, and psychosocial / lifestyle factors that can impact their day-to-day
5. Enable personalization
- Adjust care programs to meet the unique needs of each member
- Ensure educational components are modular and easy to customize
- Empower care teams to determine what information to send to members
The Outcome of Application
Adhering to these principles for member-facing care programs will generate a positive feedback loop for member engagement that is particularly feasible, cost-effective, and scalable via mobile, particularly when compared to care managers repeating information many times on the phone.
With health education that is personalized, relevant, and accessible, members will engage more often, feel better supported (satisfied), and learn how to self-manage chronic conditions more effectively.
Further, in the context of a therapeutic relationship with their care team, members’ interaction with the care program provides the kernel of insight around which the relationship is able to thrive: everything the member does with the care plan matters and informs better care. In turn, member-facing care programs advance the goals of care management and quality improvement overall, through effective health education to reduce complications, avoid readmissions, and improve outcomes.