Insurers need to engage patients, especially those with high out-of-pocket costs, to avoid poor outcomes for both parties.
When financial constraints force patients to use their insurance coverage less, the health plan and healthcare provider can lose opportunities to engage these patients in preventative health and disease management.
That's because most components of patient engagement—such as explaining a care plan, answering questions, encouraging compliance, or appointment reminders—occur during face-to-face patient encounters, says Connie Phillips-Jones, director of clinical programs at Tata Consultancy Services in Santa Clara, CA.
"Health plans can certainly be doing better towards the goal of patient engagement," says Phillips-Jones, who has a background in nursing, case management and healthcare quality.
"It will require the use of more technology and adopting some practices that are as simple as sending written reminders so a patient doesn't miss a doctor's appointment. Dentists have been doing that for years but it's relatively new to the medical market."
Patient adherence to a specific medical regimen is crucial to maintaining health and reducing costs for health plans, Phillips-Jones notes. The Centers for Medicare & Medicaid Services reported recently that a quarter of readmissions were related to medication non-adherence.
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People with chronic diseases tend to take only about half of the medications prescribed, and three-quarters do not keep follow-up appointments, she says.
"That certainly shows that there will be additional healthcare costs with those patients. The more health plans can work with patients and get them to do the right things, to follow the plan that their doctors have laid out, the more everyone benefits."
Health plans should take more advantage of the data available to them and use clinical analytics to identify patients who can benefit the most from better engagement, and those who are least likely to follow their treatment plan on their own, she says.
"It's not a broad-brush approach. You can't try to contact everyone and tell them to take their medications today," Phillips-Jones says. "You do want to be in touch with those people who most need to be engaged, and clinical analytics is the way to identify those customers from a very large patient population."
Pulling out the patients with particular diseases or conditions is only part of the effort: Health plans also need to start considering social, behavioral, economic, and cultural components that can affect the patient's likelihood of complying with a plan of care, she says.
Smartphones and tablets also offer opportunities to encourage patients more in self-care and keeping them healthy.
"When 99% of your customers are carrying smartphones, there's a tremendous opportunity to reach them and stay in touch," Phillips-Jones says.
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"Health plans are behind the curve in comparison to many other companies in the way they use smartphones and similar technology to the patients' benefit and to their benefit also. They need to start building programs to contact, to engage, to remind, and to get patients motivated."
A standard app with the health plan's logo won't be enough, however. There are already thousands of apps that can help people monitor their health, take medications regularly, and prompt them to certain behaviors, but research has shown that interest falls off after a few weeks, according to Phillips-Jones.
One way to keep patients engaged might be apps with practical purposes that are turned into games, she says.
Health plans also have learned that patients sometimes respond better to patient engagement initiated by the healthcare provider rather than the plan, so it may be more effective to funnel engagement resources through the provider, she suggests.
Gregory A. Freeman is a contributing writer for HealthLeaders.