Episode 46: “Innovations in Member Experience and Engagement Strategies” with Kim Lauersdorf from EmblemHealth, Bob Gold from GoMo Health, Dr. Nelson Le from Humana, and Phil Micali from Medical Mutual

Matt: I’m Matt Swain, and you’re listening to the “Reimagining Communications” podcast, where we discuss the opportunities and challenges facing companies on the road to optimizing their communications for the future. I recently moderated a fantastic World Congress panel discussion descriptively named “Innovations in Member Experience and Engagement Strategies that Boost Acquisition and Retention.” I’d like to share some of the highlights from that session with you today.

For context, I had four panelists participate in the session. The first was Kim Lauersdorf, Vice President of Marketing for EmblemHealth.

Kim: I'm the vice president of marketing for the EmblemHealth family of companies. One of the unique things not only do I get to engage in a lot from marketing and advertising social, events, and you name it in all the different ways we engage, but also among our different family of companies.

So that can be our health plans in New York and Connecticut, as well as our more than 40 medical offices that treat primary and specialty care, as well as our well-being digital solutions.

Matt: Then we had Bob Gold, Founder and Chief Behavioral Technologist at GoMo Health.

Bob: My field of expertise is the science of human motivation, activation, and resiliency. My application is recrafting care plans and engagement protocols to be individualized lifestyle therapies at home.

Matt: Joining Kim and Bob was Dr. Nelson Le, Associate VP of Product Strategy, Digital Health, and Analytics at Humana.

I am a pediatric cardiologist by training, but I am also a data nerd at heart. So, I've spent the last 11 years of my career in the digital health space. And at Humana, I lead the digital health product strategy. That basically means my team gets to work across the enterprise with our business partners to identify the strategic opportunities where we actually use digital analytics to really improve the lives of our members.

Matt: And lastly, we had Phil Micali, Vice President of Innovation at Medical Mutual.

Phil: I am the VP of innovation at Medical Mutual, which is a large regional plan, based in Ohio.

Like Bob, I focus on the behavioral side of the business. And I got into the business because of the engagement factor, to help folks understand how their health is their wealth.

Matt: So, you’ll be hearing more from these four panelists as we explore the session highlights.

I should also note that I set the context for the session by revealing that registrants cited their top three communications challenges as engaging members and patients with relevant, personalized content, leveraging data to create better member and patient experiences, as well as growing digital adoption.

Let’s listen in as I ask Nelson about behavioral changes he has seen among Humana’s members since the beginning of the pandemic, followed by Bob weighing in with what he’s seeing across health plans.

Dr. Le: I'm so glad you started that question because I think it's important for us to recognize the undercurrent and the context of the world we live in today. I mean, I would say all of us had to change our behaviors, right, the way we worked, the way we shopped, and the way we found basic necessities of food and toilet paper. And we all had to social distance from our friends, our families, our communities. And what we saw at Humana was that not only were people social distancing, but they were also medical distancing, right? So, people were afraid to leave their homes to go access care.

We really had to change our mindset to think about this profession, which is relatively very high touch, and transition that to a high- tech environment. So, we turned to telehealth. And, you know, it's no surprise to anyone on this call that prior to the pandemic, the utilization of telehealth was pretty minimal. At Humana it was less than 1% of our total visits were telehealth in nature. But what we did see during the height of the pandemic was that roughly 32% to 35% of our visits were now telehealth. And this was PCP visits, specialty visits, and behavioral health.

And what that taught us is that people were willing to engage in a new modality and new channel. They're willing to engage in digital health, and that we've never seen that before in the history of medicine. So that was a huge learning for us.

And then the same thing that we saw was that members were willing to migrate health into the home. Whether that be home visits or even doing procedures. One of the things that we did at Humana was we partnered with Labcorp. And I think we were the first health plan to do that, to offer COVID testing inside the home.

So that opened a whole new opportunity to think about what other testing can you do in the home? What other things from procedures can you do to bring care to people where they want it in a very convenient way? So those were the huge learnings that we saw, and the member behavior changes in the last year.

Bob: Just real quick one tactical example of what Nelson's saying, we launched with Cancer Treatment Centers of America, CVS Specialty Pharmacy, and Aetna, an oncology infusion at home program, which cuts the plan costs from about $50,000 per infusion to under $20,000. But just think about the member experience, you're at home, you know, there's a medical oncologist who does the tele-video, and in between a nurse shows up. And then GoMo is kind of the digital quarterback to manage the whole experience, the equipment, and data. So, we put four devices in the home, so we turn the home into a mini clinic.

And then I would say it really accelerated. CMS and NIH had been pushing, you know, treat the person, not just the disease, behaviorally and physically in their environment. I think we've seen a lot of movement toward that.

And just one last comment. The number one inhibitor or trigger of whether a member or a patient activates is outlook. It's been very interesting behavioral dynamics on people's outlook in general. And if you can alter an outlook slightly, you can increase activation by about three to five times.

Matt: I love that insight from Bob. “If you can alter a member’s or patient’s outlook, you can increase activation by three to five times!” Now I ask Kim to share her thoughts about which engagement shifts would be lasting versus pandemic-based.

Kim: It's my favorite type of question, which is now that we have a little bit of hindsight, what are we going to learn from it? What are we going to take from it? And where are we going to go? I think there's a couple of things and the first, I think, is around how we're going to engage. And so, Matt, you started with telehealth, which is a perfect example because we saw adoption skyrocket, we're seeing it plateau a little bit. But what we're also seeing is, with that correlated growth, we're seeing in-person growth at the same time now happening.

I think that really gives us an opportunity to say, okay, what becomes intentional channelization or intentional hybrid experiences? Do I want you...actually, I do want you to start telehealth first? I want you to start with asynchronous first. And then I intentionally want you in the office for the next one. I think as marketers, as engagement people, we've thought about multi-channel, then that became omnichannel. I think what we're learning in our opportunity is intentional channelization. Where do we want people intentionally to be engaging, right?

Something like care management, which is high touch and we're in member's homes. One of the things that the pandemic gave us an opportunity to was we actually got to go in-home on camera with people, when a lot of times our resources didn't have that opportunity before. It was a call. It was maybe once every couple quarters, we could see that, but we got to see what people were dealing with in their homes.

So how does that become intentional in the actual plan? Maybe it is a quarterly video versus a call so that you can really blend that into that. I think the how is our big takeaway, and we're going to have a lot of opportunity to optimize that.

I think the other big takeaway, and, Bob, you touched on this is the what we're really needing to do for members, engage with members on. So, the early days of the pandemic we stood up a peace of mind initiative for our Medicare members, where we call 30,000 members with one simple question, "How can we help you?" We didn't all have the answers at the time. They didn't have the answers, but we asked the question.

And what was obvious, and I know we've seen the research come out on this is isolation, loneliness, depression. Bob, I think you put it as outlook, right? And we've been as plans moving toward these social determinants of health and accelerating that. I do think coming out of the pandemic, that those no longer are nice things to look at, it's obvious in member engagement, those are must-haves as we go forward.

Matt: I applaud EmblemHealth for launching what Kim called a “peace of mind” initiative. While many of our listeners may not have the capacity to call 30,000 customers to ask how you can help, having that survey functionality built into your communications can be advantageous. We’ve seen great results in the work that we’ve done with clients on incorporating surveys into an interactive email experience to drive digital engagement.

Speaking of engagement, in the session I asked Phil Micali from Medical Mutual about how he’s creating more engaging digital experiences for members and it evolved into a discussion about the digital divide and the need to modernize systems.

Phil: Well, I would answer this question today very differently than over a year ago. But the idea of us accessing our healthcare system through a conventional telephone, cell phone, or through a video chat on a HIPAA-compliant platform, has really, again, put more of the onus on that engagement with the provider, because now they have more interactions.

I think the digital thing isn't just about the push on a cell phone and the mobile app. It's a lot about the digital enhancement or the digital capability that makes the human connection with the provider, the most convincing person to change behavior. That's where I think we're in a very, very opportunistic moment right now, is because who's going to run through a brick and mortar PCP appointment that takes three week, four, or five weeks to schedule even for a preventive thing where they can get on the phone and say, "Can I..." in two days or one day or even the same day, virtually, because the virtual system, as Bob very well understands, provides scale. It's about scale.

And that's really where I think the healthcare system now is at the crux of how do we manage scale, particularly when it's pent up and they're having to stay at home? We do it through digital interactions because we can.

Kim: I do think we need to have significant aggressive digital ambitions. But we also must do a couple of things with those ambitions. And one is understanding where the limitations are going to be, and then become solvers of those limitations. So, you're exactly right, Phil, we service New York City, one of the most diverse populations. Some may think one of the most technologically savvy, and you'd be surprised.

So when we saw the telehealth explosion happening, we actually went to market with research and looked at New York and said, if we're going to go that way, are we actually going to increase our health disparity as an industry, if we're not being mindful of all of that? And the data was boldly in our face, that a quarter of low income and black population in New York City had inadequate internet. A third had one device in the home, one device in the home.

So now if I'm balancing the ambitions of the household from online schooling to entertainment, is my telehealth visit the priority when there's one device in that? So quickly, you know, I think us recognizing, as an industry, that technology is actually a social determinant of health, that needs to be a definition that we adopt. So, one of the things that we do, we have the privilege of physical locations of community centers, they provide free Wi-Fi and they actually have telehealth pods in them. If our members share a studio apartment, multigenerational, possibly in New York City, there's a place to go.

I think digital ambitions are knowing you need to be aggressive but knowing where you're going to fall short. And then I think, Phil, the other key piece that you were touching on was the digitize high costs for scale. So EmblemHealth was one of the first recipients of the ability to do the CDC's Diabetes Prevention Program over a decade ago, at this point. Highly successful, highly intensive, a year-long program. We can touch hundreds of members; we will be committed to that. But how can we scale that? We did scale that within our wellbeing solution company, WellSpark, who digitized it. But one thing that they didn't remove, and, Matt, you touched on the personal piece of it, we kept the personal coach as part of it.

So, we digitized all the quizzes, the online classes, and all of that, and kept that personal coach engaged in the experience so now it's a complementary. Now I can scale it. And that coach isn't based on a physical can they get to a class in the middle of Queens that week, they can do a lot of classes behind the screen. And I could scale that. I think digitize the high costs, but don't lose the personal touch in the digitization.

Dr. Le: Yeah, there's a lot to unpack there. I'd love to just jump in for a second. I'm so glad you brought up the digital divide as a topic because I know that's something that we're passionate about too at Humana. The Humana Foundation has been working with the OATS organization, Older Adults Technology Services, to address the exact issue of internet connectivity.

But I wanted to touch on something that Phil mentioned around turning paper processes into digital processes. And that's not digital transformation, right, that's just modernizing your current platforms. It's also making sure you have the digital resources, and architecture, and services that's integrated on the back end. So that way, that's just your front door to get into the system.

But many of us work in organizations where there are silos and the data lives in one place, and the function lives in one place. But you may get someone digitally, but you have to quickly connect them to an entire ecosystem. So, building the infrastructure to support that is super important as well.

Bob: Just one comment, because we engage a few million Medicaid and underserved lives throughout the United States and Africa. We haven't found as big a difference in our text-only program. So, we'll ask in certain populations, "Hey, do you have the ability to receive any data or data plan or web?" And if they say, no, it reverts automatically to the text-only.

And because our science is typically delivering a thought and question at the time if they can respond to those things, it works well. And interestingly, the outcome data hasn't been, really, at all statistically different in a text-only versus some more what people would believe immersive, let's say, data experience. So, you can't reach everyone. But if you can reduce it down to the simplest point, it could help you reach more people.

Matt: This part of the discussion brought me back to the theme of the balancing act of remaining human in the digital age, which we’ve discussed in some of our other episodes, as well. I asked Bob pointedly about his thoughts on how health plans think about applying innovation and how they balance that with empathy in communications.

Bob: It's interesting because a lot of, let's say, nurses, case managers, care management physicians, they're taught motivational interviewing and empathy. But it's hard to do that when you have so many cases and you have such limited time.

I think one thing that's important, we train a lot of our plan and provider clients on best practices in integrated human digital care coordination. Because what happens from the member experience, I'll answer five questions in my digital thing. And then the case manager is asking me similar questions. And it's like, well...and then I don't even see how those questions relate to what I'm getting back digitally or human. It seems discombobulated.

If you really want to help the care managers, and care coordinators, and service coordinators of plans, there are some simple techniques to integrate the digital and human experience of the perception is it's one program, cognitively. Some things I'm getting from a human, some things I'm getting from my digital coach. Because cognitively, over time, the mind doesn't differentiate if it's providing value as a total integrated system, it's valuable, right, whether it's coming from a digital touch or human touch.

Matt: At this point we received a great question from an attendee regarding the generational – and preferential – divide, where different patients or members prefer to interact with their providers and health plans in different ways.

Kim: I think it's a great question. And I think there's a couple of different ways to think at it. I think right now we've reacted in this omnichannel world; we'll just make it available everywhere. And the member, the patient, they'll figure out where they want to get it. And all the way on the other end of that spectrum is then we'll get to language preferences, and exactly what you want.

A couple of pieces of advice that I'd layer on to the question is, one, know your member, know your patients, and what you're sitting on. What I experience every day in New York City may not be exactly what Phil is experiencing in the Ohio plan on the adoption of technology and the adoption of all those different pieces. So, one, know the data. I think is where the intentionality comes from, and to get to the messaging design, the messenger design, you got to know your customer.

Phil: You're right, know, your customer. It's a very, very different dynamic here in the Midwest, the far east of the Midwest.

But I think there's just...knowing your customer is important. And the things that I've seen so far that I've observed here that we're doing is really defining customer service more as a health advocacy – in the conventional not just the digital, but in the conventional world. That it's more about the one-and-done transaction. It's more about using the opportunity to engage with the customer, that member, and to have some kind of impact.

Bob: So behaviorally, if you're two hours or more from a facility in a rural community, you can be coded identically as someone in the city, you have to engage them differently. It's interesting because how families and communities rally and deal with adverse events, not just healthcare, that's sort of a little bit of a magic mark. Two hours or more from a facility, you have to engage them in a different protocol, period.

Phil: Well, what that says and what we all are saying, is there's a certain level of personalization that we have to achieve. And it's doing it in a scalable way is a challenge, but that's where all industries are going, and we have to do the same.

Matt: So this all goes back to the strength of the data that an organization has, how centralized and accessible that is to the business, and how it is being leveraged to increase personalization, relevance, and ultimately improve experiences. Here’s what Nelson had to say about how Humana thinks about the member data they have to influence modeling for the next best member communication in the journey… and how the team measures the outcome.

Dr. Le: We use data in every single interaction and decision that we've made. And so, I think I've mentioned before that one of our principles is that each experience leverages the insights of every experience. So, whenever we're interacting with a member, we're learning what do they need? What's important to them? How are they interacting with us? So that way, we can curate and be proactive in the next experience.

And this all starts around collecting the data, building a very longitudinal view of the member, serving up those insights. But more importantly, not only that one experience but all the adjacent experiences as well. For example, you may call Humana because you want to order a new ID card. But I should know that you were just on our digital app looking up mammograms because you're overdue for your mammogram. And I should be able to help you schedule a mammogram, even though you called in just for an ID card. So that's the idea of having an integrated system and collecting that data.

So that's super important to us around coordination and clarity, and purpose, in creating these human experiences. Now to the second part of your question, how do we measure it? I mean, I wish there was one silver bullet, we say this is the one test and you measure, and you know you deliver the positive member engagement. But there are so many dimensions to measure, Matt. There's the short term, like NPSt, there's long term and lagging indicators around call center volume, growth, the retention, NPSr. You can look at qualitative versus quantitative. There are just so many ways. And one thing that I think is important is you want to triangulate all those data points.

But secondly, look at how they're engaging the next time. Now, they may completely disengage and that's also data within itself. But are they engaging more deeply vertically, so now they're trying new features, new functions within that experience, or are they now trying new experiences horizontally? So now, I've been in the My Humana app, but I'm going to try the Humana Pharmacy experience. I'm going to try this InterWell experience, and so on and so forth. And that, for us, is very telling in the next type of engagement and is an early indicator, a proxy for a positive member experience.

Matt: So, a company effectively leveraging data for these interactions is also learning from every interaction… like what action made a member disengage and how can they be reactivated? This also led us to how each of these organizations is capturing member preferences today.

Dr. Le: We're capturing every single interaction we can. It's not a one stop shop. And again, people enter in not the way you want them to enter in. They enter in where it's convenient for them. So whichever the entry point, the front doors, you want to call it, that's an opportunity to capture preferences and what they want and how they want to access their care.

But the important thing is capturing that and then sharing that across. It's like what Phil said, you're not answering the same questions over and over and over, it's shared insights. And there's no one preference center because we're all capturing preferences.

Kim: Yeah, so the distinction that I'll add on top of what Nelson has said is capturing is one thing, storing is another, and activating is another. I think it is important to understand the pieces of that strategy, understand what the technology infrastructure is connecting that, and understand the components. From a marketing lens, and I think about the capture, right, one of the things that's important and we just went through this exercise recently is consistency in the capture. The questions you ask on the enrollment form versus what I'm asking when I'm in front of a doctor, versus the online enrollment form, versus what the sales rep grabbed, right, the consistency in that is critical. Otherwise, what do you have in your storage base, it becomes a little bit of a challenge if you've asked the question in a different way.

So, first, I would focus on getting the capture right, then it's about the storage, and your IT friends are going to be your friends on that, where your preference center is. And then it's making sure all your roads are connected to pull that out. So, making sure it gets into my marketing database, making sure it gets into my technology platform, so that I know.

Bob: So, I think there's two parts of this. There's one, people have certain preferences based on they know what they know. "I like this, I like that, my lifestyle is this." But healthcare, just like going to a car mechanic, a lot of it is blind. Do I have a preference on how to be cared for, I want maybe somebody to help me with that? So one of the interesting things is when we collect information...so let's say you just divided for purposes of today into practically problems, what people call social determinants, or financial, behavioral challenges, and then physical challenges based on what you're going through.

The key is the correlated algorithms to help the care team, whether it's the plan or provider, with how to quickly sift through that to reach an insight. Because having tons of data may be as useless or useful of having no data because what do you do with it all? How do you correlate those elements?

And that's where integrating a behavioral science into the correlations to say, if Miss Jones indicated anxiety twice, and her blood pressure was this, it means that. I think that's where we got to get to Kim's point to activate this...to help the care teams activate it. Because at some point, it's just a massive amount of data that's cognitive overload for everybody.

Matt: And to wrap the session, I had each panelist share their thoughts on the most important things for attendees to take away from the session.

Phil: We've learned a lot in the last year, it's made this conversation much richer than it would if the pandemic didn't happen. And there was an uptick in digital interactions with the healthcare system. The other thing that I've learned is that our interactions with the healthcare system, digital or not, are condition specific. They're really related to conditions.

And so, what happens between those conditions and the messages we want to hear? What's kind of got me going here in this conversation, what do we want to hear from our healthcare system, which is really a sick care system, for that condition we were sick at? And what are the messages we want in between about wellness? But we know our healthcare system isn't as good as wellness yet, as it is in other countries with a strong public health, strong primary care base that we don't yet have. So that's just some of the stuff that I left with more questions than really answers.

Dr. Le: This is hard work but it's a rewarding work. And at the core of healthcare, it's around building trust, and it's around delivering human experiences and human care. To do that, it's got to be personalized, right, it's got to be easy to access and simplified. We got to make this so much easier for our members to be proactive in taking care of their health. Let us really keep the members and our patients at the core of our work and really deliver human care.

Bob: One thing with the aging population and a lot more people surviving and needing healthcare is integrating family members and caregivers into the healthcare ecosystem. And if you look 20 years from now, you will need a lot more healthcare workers to service the need. So, I think that's my message, how do you use alternative provider networks to handle the growing need?

Kim: I think my biggest takeaway and I always appreciate these conversations is that our challenges are the same. The challenges are not the unique part of this, and so it really comes down to how. And we've taken the approach with a family of companies to be in the plan, be in the delivery system and be in the wellness solutions. And now what it takes is a curiosity every day to have these conversations and ask these questions, that's when change will come.

Matt: I told you these were great panelists! And what a great way to end our podcast. If you’re trying to improve experiences for your members, patients, policy holders, customers, account holders, investors, or otherwise, hopefully you’ll think of Broadridge to help you reimagine these communications.

I’m Matt Swain, and you've been listening to the "Reimagining Communications" podcast. If you liked this episode and think someone else would too, please share it, leave a review, and don't forget to subscribe.

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