A Health Plan’s Guide to Better Member Experience and More Accessible Care

From the makeup of their workforces to where they operate to their expectations around healthcare benefits, no two employers are the same.  

Health plans are in a unique position, looking to address challenges that are as different as the employers they serve, while also solving one underlying problem that’s important for them all: poor member experience. 

Healthcare remains frustratingly fragmented. Most people are familiar with long stints in the waiting room, limited appointment availability, rising out-of-pocket spend, and shortages of primary and behavioral health providers. It all results in dissatisfaction—and, too often, delayed, or abandoned care for members. Meanwhile, health plans experience difficulty looking to deliver member-centered care, manage costs, control premiums, and improve access, all at the same time. 

However, there’s good news: Health plans don’t have to solve the member satisfaction problem alone. By partnering with a direct healthcare provider, payers can improve access, boost outcomes, and create a seamless, high-quality experience for their members – all without breaking the bank. 

Enhancing access through convenience and integration 

Direct healthcare models are built to overcome the access issues that plague many parts of the healthcare system. This is especially true of direct healthcare solutions that leverage an advanced primary care model, which is designed to meet members where they are in a way that conveniently fills gaps in care. 

Here’s an example: When virtual and in-person care is available through an integrated platform, members can get care however works best for them. At an onsite or nearsite wellness center, they can get same-day and next-day appointments in-person with their care team, including primary care providers and licensed counselors. Or, if they need care overnight, away from home, or after hours, digital health solutions make it easier for members to get the care they need from wherever they are. 

As a result, members no longer face long waits and can start feeling better, faster. And because virtual and in-person services can be delivered through a single system with one electronic health record (EHR) like Epic, the experience is seamless across all touchpoints, meaning members don’t have to recite their medical history at every appointment. 

Member engagement has to start early—and stay steady 

Engaging members isn’t something that can happen after the fact – after all, if members don’t know about their benefits, they can’t use them properly. When health plans begin a partnership with a direct healthcare partner, they collaborate to develop a tailored member engagement strategy that educates members about the care model and builds trust from day one. 

Member experience teams work with health plans to ensure the right messages reach the right people, using tools like personalized email outreach, health center events, and integration into existing tools, like health benefits portals. 

Members aren’t just told about the services available; they’re shown how to access and use them in a way that feels relevant to their needs and receive ongoing education about the kind of care available to them. It’s this kind of intentional communication that turns eligible members into active participants in their health, prompts them to seek preventive care, and improves health outcomes down the line. 

A team-based approach to proactive, personalized care 

Improved access is important, but creating a better member experience also means empowering providers to work together for the good of their members. Direct healthcare brings together the entire care team – primary care providers, counselors, pharmacists, care navigators, and more – so they can work together to support a member’s whole-person health and minimize opportunities for gaps in care. 

Technology makes this possible: Providers share information through the same EHR, which eliminates duplicative care and streamlines the referral process. If a member needs specialty support, they’re guided to affordable, high-quality care, reducing downstream cost. 

Rather than waiting for members to seek care, care teams can also use population health data to identify high-risk individuals – like those managing or at risk of developing chronic conditions – and reach out proactively to offer resources. As a result, members can build trusted relationships with providers, and have conversations to address critical health concerns before they emerge or worsen. And by getting high-risk members engaged early, these providers are then able to reduce expensive emergency department and hospital visits, improving outcomes while controlling healthcare spend.  

Delivering value where it matters most 

When members are satisfied, healthier, and more engaged, everyone benefits – from their family members to the health plans that serve them. 

When health plans partner with direct healthcare companies, they lower out-of-pocket costs for members by offering low- or no-copay visits to services like primary care and behavioral health. And when members have longer appointments with their providers learning ways to improve their lifestyles and prevent costly conditions, they spend less time in the hospital or urgent care and more time doing the things they love. 

Meanwhile, employers see better health outcomes among their people, reduced absenteeism and presenteeism that can impact productivity, and lower turnover from employees who love their benefits. Plus, that same reduction in costly conditions, ER visits, and inpatient stays results in lower overall healthcare spending for employers, too. 

Create a better healthcare experience for your members 

In today’s evolving health plan landscape, the ability to offer integrated healthcare that’s accessible, affordable, and member-focused gives plans an innovative edge over the competition. When health plans embrace advanced primary care, they gain a powerful ally in their mission to improve outcomes and control costs while boosting satisfaction for their members. 

At Premise Health, we partner with health plans to create smarter, more personalized healthcare solutions that elevate member engagement and satisfaction. Ready to expand access, improve care coordination, and design more impactful benefits? Get in touch today.