How to help your members find the right care

December 3, 2020
Josie Rasberry

Finding the right care for each individual patient is the first step in resolving any medical event. If you don’t get that first step right, it’s going to lead to frustration, headaches, and in the worst case a delay in receiving appropriate care that may lead to worse outcomes.

As someone responsible for ensuring members find the right care (whether a health insurer, health cost sharing group, TPA, or even a self-insured employer), you want your members to find the right care the first time and you want that experience to be as easy as possible.

To help you reach your goal, we’ve provided a few tips that will make healthcare easier to find for your members.

Explain their benefits.

And we mean really explain, in layman’s terms. Make sure members can clearly understand in-network vs out-of-network, their copay, their deductible, all of it. So often people make poor healthcare decisions simply because they don’t understand how their insurance works. Taking the time to clearly explain how coverage works could mean the difference between your member going to an in-network doctor you’ve contracted with and receiving an expensive bill from an out-of-network doctor. Having trained patient advocates and care managers who can help your members understand their options in advance of a need can make all the difference.

Offer shopping tools.

Better yet, if you have contracts with providers, be upfront and tell members how much a surgery, a specialist visit, etc. will cost them. If you can’t, there are several tools out there to help members shop around for healthcare. Not to toot our own horn, but we think our healthcare navigation platform and marketplace is a great place to start. Not only can members see the price for several medical services, they can also search and compare to find the doctor, hospital, or specialist best suited for their needs. Best of all for payers, the search and comparison tool can also show members which providers you have and haven’t contracted with. You can also send members to some of the resources in this health shopping list compiled by David Balat of Right on Health.

Be an advocate.

Whether you decide to do it in-house or through a third party, offering a team of advocates to your members can be a great way to make sure they feel supported during healthcare experiences. A patient advocate who can help answer questions and offer suggestions on where to receive care will not only create a better experience for your members (which means good member retention for you) but will also avoid unnecessarily expensive medical bills.

With patient advocacy, you could even take it a step further by having actual registered nurses or other healthcare professionals who can help guide a member to the right type of care. It’s also important to remember to offer cost savings solutions to members if they need care that isn’t covered by insurance, or is barely covered. Tell members about cash pay options if they’re going to end up paying out-of-pocket anyway, or advise they go to an ambulatory surgery center instead of a hospital if that will save them money.

Simple search tools.

A lot of big name health insurers have their own online platforms where members can search for in-network providers, but these can often be confusing to navigate and don’t have everything the member needs in one place. Consider offering a healthcare navigation platform that makes searching for care easier on members, or if you already have a platform, make sure to review member feedback and fix the issues they report. If you can’t create your own member platform, there are third-party services available that make it easy for you and your members to experience a better healthcare search.

As you know, when a member needs medical care, finding care is the obvious first step. This means it’s also extra important to get that first step right. Finding the ideal care the first time will save the member time, money, and stress and will help you offer a better member experience that also saves you resources.

Download the Complete Guide to Retaining Health Plan Members.

Learn the best strategies and tips for retaining your members while keeping costs low.

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