How Payers Can Realize Hard ROI From Hyperpersonalization

A new report from Lirio and insights from company executives details how AI plus behavioral science bridges payer-member divides and helps capture lost ROI.

Personalization has been a paradox for payers. Health plan leaders believe that personalized member outreach is important at every stage of care but are still in search of results. The title of a new report from Lirio suggests the solution. (Re)defining personalization: Unlocking the future of superior member engagement and outcomes highlights the importance of “hyperpersonalization” — an approach designed to deliver hard ROI for health plans and lasting health outcomes for members.

Lirio CEO Dr. Marten den Haring describes the challenge well.

“Hyperpersonalization doesn’t mean more engagement but rather the right kind of engagement, delivered in the right way, and at the right time and frequency.”

This HealthLeaders exclusive with den Haring and Lirio’s Chief Behavioral Officer Dr. Amy Bucher details how payers can gain hard ROI from hyperpersonalization that combines artificial intelligence and behavioral science.

Why personalization hasn’t worked: High importance, zero satisfaction

The Lirio report, conducted by Sage Growth Partners, is based on surveys from 70 national and regional health plan leaders. With data on payer AI use, member engagement, and the consumer experience, key takeaways include:

• 60% of health plan leaders indicated that engaging members to improve quality of care was their top challenge
   
• Many believe that personalization can aid engagement across the health journey, including 77% for chronic care
   
• Yet 0% of payer executives are extremely satisfied with their plan’s member engagement performance.

Other data suggests that core misunderstandings keep payers from investing in personalization.

"There is a question in our survey that I'm really glad we asked, because it reveals how much health plan leaders believe that there is a lack of motivation on the member side,” says Bucher.

In the Lirio report, 84% of health plans say that members are unmotivated to make necessary changes and that that is the most significant barrier to outreach.

“It's my belief that it's actually a failure to personalize, to talk to people, to get to know them in a way that allows us to tap into the things that motivate them well,” the CBO adds. “There is a disconnect between what they think personalization is and what it really is.”

Payer Playbook Step 1: Understand what personalization is and what it is not

Lirio’s CEO believes that questioning traditional definitions of personalization is the first step toward realizing hard ROI.

"As a health plan, if I build the member experience the way I would build a consumer experience, I need to start asking myself some hard questions, says den Haring.

“These include what is the relationship that I want to create and craft with my member to optimize outcomes."

Lirio notes that the industry usually defines personalization as batch-send emails and texts that simply include the patient’s name.

“Is sending an email with 'Hi Marten' personalization? Do you know what motivates me?” says den Haring. “We need to fill in the gap between the assumptions that we're making and how to actually get people to take the actions that we want them to take by starting at the very top level.”

These assumptions also include segmentation, identifying patients by their demographics, conditions or risks.

Bucher adds: “Segmentation is not personalization. Health plans must personalize along dimensions that actually engage people. A big job of personalization is shifting the language of members and payers — bringing them more together and bridging this fundamental divide.”

Lirio is shifting the language with a new term — hyperpersonalization.

Payer Playbook Step 2: Hyperpersonalization where AI meets BeSci

Lirio defines hyperpersonalization as an “n of 1” — an approach that truly understands the unique needs, motivations and behaviors of each individual patient to deliver better outcomes.

Lirio has combined two elements to design its n of 1 approach: Artificial intelligence (AI) and behavioral science (BeSci). AI can deliver precision engagement while BeSci leverages the cognitive, social, and environmental forces that shape behavior.

"N of one is the Holy Grail, but it's misrepresented in healthcare,” says den Haring.

"I don't think you can actually achieve a person-centered experience unless you understand from a design point of view what you're trying to achieve,” the Lirio CEO adds. “It's a combination of subject matter expertise and behavioral science on the design side that involves a lot of research and a lot of tools.”

Lirio embeds AI and BeSci into its member outreach platform, which includes a Personalization Engine and Intelligence Layer. Together, they use real behavioral interactions and outcomes to continually refine key messages and images to uniquely motivate each member through four core capabilities:

1. Know the member based on comprehensive, integrated data. This includes data that Lirio’s platform creates based on BeSci principles.
    

“Lirio can generate rich data for health plans that might not emerge without behavioral science training,” says Bucher.
 

2. Orchestrate behavioral interventions including “Lego blocks” of content, images, outreach formats and frequencies that tailor messages in real time based on evolving needs and behaviors.
    

“Most of healthcare is not about doing one thing one time or even a lot of things at one time. It's about developing habits, changing a lifestyle, creating more sustainable behavioral patterns,” Bucher adds.
 

3. Learn from member behavior, continuously and automatically until the desired outcomes are achieved. Lirio’s Large Behavior Model “uses real behavioral interactions and outcomes to continually refine key messages and images to uniquely motivate each patient/member.”
    

“If what's needed is a low-effort behavior, the member might just need a reminder to take their medication. Other times,” Bucher adds “it might take a little bit more, like talking about how to overcome a barrier to a new behavior.”
 

4. Move to better health through personalization that begets more personalization that is designed to get results, for not only the member but the health plan.
    

Says Bucher: “Personalization is a really important ingredient, not in just getting people to start behavior change, but in getting them to sustain it.

Payer Playbook Step 3 — Seek hard ROI in multiple areas

One final but important data point from the Lirio report: Tech investments “skew more short-term” with more payers (61%) planning to invest in population health analytics to support member outreach versus AI (54%) and advanced personalization technology (46%).

den Haring sees a disconnect.

“Tech and AI must be part of the solution but many payers don’t understand what hard ROI is in this space and how to deploy tech to get it.”

The Lirio CEO and CBO Bucher identify several hard ROI potentials for health plans:

1. Adopting a personalization framework that also compares claims cost approaches
    
2. Focusing on areas where personalization is closely tied to medical loss ratio (MLR) and where margins have gotten thinner
    
3. Using personalization to address staffing costs and burdens (e.g. BeSci-driven automation that supports Care Managers)
    
4. Investing in a “less is more” approach

Here, den Haring notes: “Hyperpersonalization includes reducing the amount of human touch that’s not effective. If an outreach or intervention didn’t work three times, why would it work four?”

He adds: “We're a little too focused on copying and pasting approaches from other industries and applying them as though healthcare was Amazon or Netflix. Healthcare’s challenges are very, very different, and therefore the tools are very different. I don't think a health plan's main goal is for me to buy a bunch of product or spend more time on their portal.

“I think what health plans are really trying to do is to give me enough resources, services and support so that I can live my life as healthy as I can and make good choices. Ultimately, that should reduce costs and risks for the health plan."