Strategies to Enhance Digital Member Engagement

Ciji Adams: Hello, and welcome to The Payor Principle. A Salesforce healthcare podcast created exclusively for payors. I'm your host, Ciji Adams. On the show, you'll hear insights from healthcare industry experts in trailblazer organizations on all things payors, such as trends, business challenges, and the latest technological solutions. Today's episode focuses on digital member engagement. I'm joined by Kevin Riley, senior vice president and GM for health and life sciences at Salesforce, who has over 25 years experience, building solutions for healthcare companies. Kevin, welcome to the podcast. It's great to have you.

Kevin Riley: It's such a pleasure to be here.

Ciji Adams: So, we know that today's healthcare consumer is more digitally savvier than ever. The connected consumer healthcare report from Salesforce actually states that consumers want real- time communication with healthcare organizations. The research showed that 69% of consumers want SMS text capabilities, 55% want online messaging or live chat, and 38% want live video offerings from their providers and payors. So, Kevin, what does this mean for engagement with members during COVID- 19?

Kevin Riley: So, when you're talking digital, what you're implying is, members can serve themselves. So, some would say," Let's look at it under the metric of the measurement, call deflection." But that's really antithetical to high customer service. Just because someone didn't pick up the phone and cost you time in solving their problem doesn't mean that they were well taken care of or served. So, those types of measurements are quickly taking a back seat to more important measurements. And so, when we think about engagement and digital interactions, we break it down using Clay Christensen's model. It's the job to be done. What's their capacity to understand how to solve it, and what's their propensity to take action against it? So, if you can look at the member holistically, and understand both their capacity for understanding, which implies then their propensity to solve, you can actually tailor the message back to them. And this becomes especially important during COVID- 19 because you've got a mix of known and unknown jobs to be done. So, perhaps someone calls you and they want to know more about," What are my benefits, and do they cover COVID- 19 testing, or what happens if I get sick?" So, those types of aspects are pretty predetermined. And if you can put messaging in place, in a digital portal or in a mobile app, that can help people understand, and you're guesstimating that they're coming in for this information, which is a pretty, probably good guests, then you're going to be safe. But you still have to be able to respond to the actual job to be done. So, were most engagements fail, COVID or otherwise, is they make the user think about how do I actually initiate what I came here to do. The easier and faster you get them activating against their job to be done, the better you can determine their capacity for understanding and actioning against that, and their propensity or willingness to actually follow through, the more you're going to have a satisfied, served, completed job to be done, and a happy member. Rather than call deflection. It's really about, are you doing the Triple Aim? Are you giving somebody the proper service? So, as to produce the best outcome with implied highest levels of satisfaction.

Ciji Adams: So, really by having a keen understanding of that propensity versus a member's capacity, you're feeling that payors are setting themselves up to be able to achieve better member satisfaction, essentially.

Kevin Riley: They are. And you know that they get paid for that. So, if it's government- sponsored business, CAP surveys imply a happy member. Happy members mean you're actually getting higher reimbursement. And so, fewer calls in because people can self handle happier members that will anecdotally refer you to other people, happy members that actually help fill out CAPS responses to make your measurements higher. All this means, direct and indirect improvement in the revenue these plans produce. So, there's a pretty self- serving reason for doing this, but if you go a little bit deeper, as we like to do, you've got to try to approach the member in a humanistic way, knowing that every member, regardless of the similarities we have in problems, we all have differences in our situational fluency. So, my ability to handle one thing may be fantastic and very low on another thing. And it's hard for you to market segment or to classify my capacity/ propensity when just having me click a digital interaction. If you launch the interaction from the job to be done, you are positioning yourself into a moment of context. You're here, Ciji, to do this thing. I've helped you initiate this thing. Now, I've created the context for you to learn and activate and act against it. And if I solve that problem, I'm now in a position of trust. So, I've taken a moment of context and I've turned that into a position of trust. And human nature tells us, as well as market research and science, that if you fulfill somebody's obligation put upon you, and you create that moment of trust, you are now in an advantageous position to actually get something from them. And that's really the key to what you're trying to do with digital interaction. And this is the key to establishing a long- term trust and loyalty equation in a very well adjusted member. And what do I mean by that? I mean, a member whose risk is codified, who's approaching with gravity and seriousness and, at least, competency to solving their health profile. And this creates the ideal type of member for a health plan. You don't just want people who don't ever get sick. You want people who understand and are willing to act against known information. So, using the opportunity to solve a problem, to help them realize more about their unknown information, and then take action against it, to me, is the highest order of digital engagement. And that's what we're trying to solve for, every time we create any sort of guide of interaction.

Ciji Adams: Well, you've made so many salient points there, going back to the fact of understanding what exactly is the job to be done, succeeding at that with a member, and then getting the opportunity to find other jobs to be done, and demonstrate your capacity to understand the member, to meet their needs in establishing that level of trust, that in the long run, you're hoping will convert as a payor into long- term loyalty and retention. So, now that we kind of have this understanding of what digital engagement means and how critical it is when we think about member outcomes, I want to go back to your mention about making it easy for members to access information in resources, digitally. Often for members, this occurs from their health plans at digital portal. The connected consumer report from Salesforce States that 82% of consumers say it's important for their health care companies to offer personalized web portals. So, how can payors empower members to take their health into their own hands digitally, especially when it comes to web portals and self- service?

Kevin Riley: The irony of that Salesforce report is you've got this dichotomy of the member basically saying," Health plan. This is really important to me. You should do this." But yet there's such low uptake on the actual digital portals. And so, is it a branding awareness thing? Do they not have the link? I don't think that's the case. If 82% of the member populous says," You need to do this," It's not because they're not aware of it. It's because it's not easy for them to do that. And I think that's what's implied. If you're not making it easy, you're not getting the actions you want. Now, I once had a designer... This is really, I think, evidentiary anecdotal story to help everybody understand that nobody gets it right their first time around. And we had created these interfaces that really showed all the core information that a contact center representative. So, the person on the other end of that digital self- service action... when somebody actually calls in, they have this amazing portal with access to everything at their fingertips. And we were so proud of it because it was chock- full of nuts. It had absolutely everything from A to Z, inside of this interface, it was really actionable and you could click on everything you want it to do. And one of our top humanistic designer said," Wow, I would hate to work at that company." And I thought," What an odd thing to say? Why would you say that?" And he said," Because, frankly, just doing that job seems like it would be impossible. Having to know all these places to click and all these things to do, it seems like you're setting up the contact center rep for failure." And no wonder they have such a low customer happiness score because you're making it very difficult. So, I said,"This is really interesting. Well, how would you do it?" And she opened up a web browser and said," Well, what's the most used application on the planet?" I said," Google." She says," Right? What's there? It's a white page with a box and a button." And it really struck all of us in the room as," Wow, that's really we want to strive for." We want to have a minimalistic interface with the capability to say," What do you want to do today?" And not return records so that you have to go figure out what you want to do, but return actions. You tell me a little bit of information and I will return to you a bunch of actions you can take. And if you click one of those actions, well, now we're moving forward. And that's what I mean, Ciji, that's how you make it easy. You make it Google- like in essence that I know that, here's this interface. I can type something into it. I could type in the word, pay, and I return back a bunch of things. Do you want to make a payment, Kevin? Do you want to sign up for eBilling? Do you want to see your last four payments or do you want to have an inquiry against one of those payments? All the actions I could do could be presented relevantly right there. Once I select, now you can paint the screen to be indicative of the context of the job to be done, you're currently involved in. And when that's completed, you can paint the screen again to apply all those opportunistic and contextual next best jobs to be done.

Ciji Adams: So, you've listed out a lot of great points around how to basically make web portals easier for members to navigate, including leveraging next best actions, inaudible making the text or the search function really simple. What other ways are you seeing payors, maybe, struggle to simplify their web portals and what could they be doing more, even if we think about personalization and making it something that entices members to be more apt to want to actually log on and use those portals?

Kevin Riley: One thing is, don't reinvent the interface. Don't try to make it look unique. Make it follow the visual patterns that people are already used to. As a health plan, you don't set the digital standard. You're not the de facto way that people operate. Amazon is. And even Amazon, to a degree, can be very complex and overwhelming. I certainly wouldn't want to receive my healthcare with 10, 000 different choices, with member ratings against it. I want easy. So, I want to have an opportunity, as a health plan, to benefit from the design patterns that people are used to using already. I want to have a minimalistic approach. I want to not return records, I want to return actions. And I complete an action, I want to give somebody the next best action.

Ciji Adams: Kevin, we'd be remiss to discuss digital engagement without talking about AI? How does AI facilitate deeper digital engagement, in your opinion?

Kevin Riley: Now, what you'll often hear health plans say is," Well, shouldn't we jump right to artificial intelligence." And I say," Well, that's great, but you're still struggling with usability. And if you haven't surpassed that hurdle that's created, where 82% of your member population says, you really need to drive more information in a digital format, they're not asking for artificial intelligence yet. What they're asking for is simplicity, so that they can actually drive to the action, the job to be done very quickly." Now, having said that, where artificial intelligence is essential is that, by doing these earlier steps that we talked about, you're actually also recording content about the individual. So you can see by the way they click, their click patterns and where they came in from, and other information that you can gather and glean as they click through the portal, you can build up additional content about them. So, you combine that content you already have, their demographic profile and their claims information, you combine the content you receive from these digital interactions, like," What is my job to be done? And how do I follow through with that job to be done? And how do I counter whatever you present to me? What am I actually clicking on next?" Well, now you're driving content. And AI is an intent engine. It can't tell you what's implied unless you give it sufficient amount of information. But if you do give it sufficient amount of information, this is where propensity comes in. It's really hard to determine, Ciji, what your propensity to do something is, even if I make it easy for you to do the job to be done, to complete the action in a truly digital, 100% digital, straight- through processing manner, I don't have a lot of information about your propensity to act on it. This is where, when the health plan is ready, artificial intelligence becomes absolutely essential. Because you can combine the action of the job to be done with the content that you've gathered and augmented through your own legacy systems, to drive that information into something like Salesforce Einstein, to say," Okay, not only here's what you should do next, but here's the propensity for the person to act on it." That's where artificial intelligence will separate good health plans from absolutely phenomenal ones because it will be so tuned in to what the actual individual is able to do, not just what they should do, but what they're able to do. It really makes the difference. And that's where you're going to get uptake. So, jobs be done easy is step one, and then you jump to content to intent artificial intelligence for step two. This will drive contextually based next best actions, and give you the intelligently placed next best action with a high propensity to take action. This is how you make healthier populations through a digital means.

Ciji Adams: Well, that's such a great breakdown, Kevin, and I think you really hone in on the fact that AI really has the ability to help members lead healthier lives. And whether that's allowing payors to collect more information about their members, so they can have a deeper understanding of them, their needs, their pain points, and how to better service them, or it's surfacing up those intelligent recommendations proactively, based on what now, I, as a health plan, know about a member based on the data that I've collected about their health. AI really has the potential to influence positive, I would say, member and business outcomes.

Kevin Riley: Absolutely.

Ciji Adams: So, while we're thinking about that, what about care management? What does it look like to actually educate members digitally, and entice them to act, and basically, engage and better manage their care from a care coordination or care management perspective?

Kevin Riley: This is a perfect question because it's at the heart of transformational change at the individual member level, when aggregated, becomes transformational change for the member population, which aggregated again, becomes transformational change for the entire society at large. And you're talking about one of the most interesting concepts. Everybody on earth is affected by their health. And very, very few of us actually have, what I would call, situational fluency to do something about it. That's that rare thing that we've got a dependency on being healthy, but we don't really truly know what to do. And so, there's just not enough doctors or access to care to make this viable and affordable, how do you then digitize it? Well, if you look at the history of how health plans are first digitized, it's been the health risk assessment. And that's met with very mixed results. Initially, I thought they were quite good, because historically speaking, members had very, very little information outside of their explanation of benefits. They didn't ever think about their health holistically, only transactionally." I went to see my doctor for this thing." So, with the health risk assessment, you had this very simplistic, formulaic digital method to actually gather information about somebody and then represent some common things that they could do. Well, great. I've got information, but the actionability of the health plan was very weak. And this, Ciji, is where I think health plans need to be a little bit more proactive through the digital environment of reminding people with small, simple, actionable steps. Not telling them what they should go do, but reminding theme," Here is a thing that you could do, click here and take action against it." And if you really want to make that actionable, put a loyalty or reward system behind it as well. I've always had this vision where a health plan that has to spend so much on qualified medical expenses, takes money and applies it towards a loyalty/ wellness program that was affiliated through the physician. So imagine, Ciji, you go to your doctor, your doctor says," Ciji, here's what's currently right about you, and here's what needs to be fixed. And if you will go do these things, I will actually give you store credit to the wellness store. And you can use some of the credit right now to buy some of these tools, these digital tools, a Withing scale, an electronic glucometer, an iWatch. I will give you credit to go and actually take action against these, so that you can then begin to improve, on your own terms, in a tailored, personalized way, but you're taking action against this known thing." I just imagine that this is the better answer, than a health plan trying to do it themselves, why not facilitate it through the point of care through the doctor? So, the patient has contextual awareness of what the doctor's telling them to do. They've got the gravitas of their physician saying," This is what I want you to go do. And you know what? I know life is tough. I know it's hard to get this stuff done, but I'm going to motivate you. And I'm going to enable you by giving you credit at the digital storefront, to allow you to get the things that you need, to go and take action against this care plan I've given you."

Ciji Adams: Well, I think that's inaudible that wellness programs we're seeing today are largely successful with the way that they're incentivizing structure works to encourage members, to exhibit healthier behaviors.

Kevin Riley: But they work. Those wellness programs have hit onto something, and they work for certain populous. It is my anecdotal belief that's actually backed up by a lot of conversations with a lot of providers and health plans too. That, if you did this through the provider, you would have much more action. There's an importance that's implied when the provider says it. My wife tells me," I need to work out more and exercise." I take it to heart. My doctor says," Kevin, you've got to get more exercise." Starting Monday, I start a new program. And that's the usual modus operandi. And so, if you can take that highest, most valuable care engagement, which is your communication, one- to- one with your care provider, and you can couple it with a completely aware digital transformation program, tailored to the individual, that comes with a loyalty and reward mechanism to impact higher outcomes and results, well, I think you've got the better mousetrap right there. And so, that's what we're striving for, to create the capability set for health plans to be able to do that, and do that through the point of care and that really trusted source, the provider.

Ciji Adams: So, Kevin, what happens if a pair doesn't necessarily get digital engagement right? What are the advantages, essentially for them to getting it done correctly, and what do they stand to gain by doing the job to be done, well, that you referenced earlier?

Kevin Riley: Great question. I think proof's in the pudding. So, one, if you get it right digitally, you get paid higher. Five- star quality ratings achieve much higher payment optimization. We know that if you have a high- risk population that's known, risk corridors help you get paid a lot more money. And there's a lot of evidence of that. There's some recent news that just got released from one of our customers, where they've done that extraordinarily successful, to the tune of a billion dollars. And so health plans-

Ciji Adams: Wow.

Kevin Riley: Yeah. Serious money. Health plans can make 10 to 15% additional revenue on their current member population by having higher member satisfaction, higher codified risk profiles of their patients or their members, and having those members actually enact in a actionable plan, a care plan. And so, those that don't get it right are doomed to failure, they will cease to exist. If you aren't digitally engaging. If you're not serious about this, then you can assume you're going to get lower ratings. You're going to assume that others are going to be able to market more often. They're going to be able to market better because they've got higher quality ratings. You're going to assume that, all things being equal, the company with a really cool digital interface is going to be better than the one without. I think that's evidenced by just comparing Medicare advantage to Medicare. If you look what private payors have done in Medicare advantage, throwing in all these other great bells and whistles on top of Medicare, it's easy to see that when you give them more and you give them choice, they're going to choose that. So, to me, if a payor is not trying to digitally engage right now, and taking it really serious, they're not serious about longevity in the market. Because the big ones, I assure you, are transforming their entire company around the customer. Payors are moving from the concept of," I just have to manage my risk the right way and make sure that I can take in my premium, to becoming truly member- oriented businesses, where the lifetime value of that member well exceeds anything that any health plan has seen, historically, over the classic health insurance premium collection model.

Ciji Adams: Kevin, we've covered so much ground today. I want to thank you so much for joining and sharing your insights with us.

Kevin Riley: I'm really grateful for you putting this together. I think this is important and I enjoy having a dialogue about it.

Ciji Adams: Listeners, if you want to learn more about our payor solutions and how you can digitize the member experience, visit salesforce. com/ healthcare. I'm your host, Ciji Adams. Thank you for listening.