The modern data stack is transforming the way innovative medical insurance payers operate. By leveraging a Member 360 approach with cutting-edge data tools, payers can now elegantly synthesize member data in order to drive better healthcare outcomes for members and bolster ROI.
The logic is simple: unify as much user quality data as possible so that it can be analyzed holistically by cutting-edge data tools to generate game-changing insights. But how exactly are payers achieving this?
The Member 360 Approach achieves this by offering a comprehensive, data-driven model that combines and analyzes all aspects of a member’s health journey, from clinical data to social determinants of health (SDOH), member interactions, and care management activities.
Under the Member 360 Approach, a member’s profile integrates data from claims, doctor visits, prescriptions, wellness programs, social factors (e.g., income, housing), and member service interactions. By leveraging all of this data holistically, payers can tap into truly innovative data practices.
In this article, we’ll take a look at seven key benefits that come with the Member 360 Strategy to better understand why this approach is so powerful for payers looking to build a state-of-art data stack that optimizes their operations.
1. Understanding and Addressing Social Determinants of Health (SDOH)
SDOH refers to the non-medical factors that influence health outcomes, such as socioeconomic status, access to healthy food, education, and safe housing. Automated analysis of this information can be used to direct members to resources that will boost their healthcare outcomes in less obvious ways than straightforward treatment options.
For instance, a member with high social needs (e.g., housing instability or food insecurity) may benefit from targeted outreach programs like connecting them with local community resources or health-related social services.
By identifying SDOH through a Member 360 approach, payers can address root causes of health disparities and improve long-term outcomes for vulnerable members.
2. Enhancing Member Satisfaction through Personalized Experiences
With the Member 360 approach, payers can tailor communication, programs, and care interventions to individual member profiles, including health status, preferences, and past behaviors. This automated process can use these data points to better accommodate unique patient needs.
For example, a member with a chronic condition like diabetes could receive specific educational content on managing their disease or personalized reminders for screenings or medication refills.
This strategy can lead to increased member engagement and satisfaction, which in turn leads to higher retention and better health outcomes. Personalization fosters trust and loyalty to the insurance provider.
3. Advanced Risk Analysis and Predictive Modeling
Using historical data, predictive analytics can help identify members at high risk for developing chronic conditions or experiencing adverse health events. This sort of preventive care takes advantage of holistic data sets to head off potential health issues before they develop into serious conditions.
With a Member 360 approach, payers can identify members at risk for conditions like heart disease or diabetes through claims and clinical data, allowing the payer to proactively reach out with preventative care or early intervention programs.
This strategy leads to healthier populations and more efficient care delivery, which in turn produces reduced costs through early intervention and preventative measures.
4. Improving Operational Metrics and Efficiency
Using Member 360 data to analyze call center interactions, including the reasons for calls and resolution times, can highlight pain points in the member experience. Reviewing processes in this way allows payers to adapt more quickly in order to ensure better interactions with members.
For instance, a payer may identify a frequent issue with members calling about the same coverage question and use this data to simplify the communication or provide better self-service options. This process could take only weeks or days of review, as compared to the months or years that would be required with manual oversight.
The ripple effect of benefits produced by this approach are invaluable. Streamlining operations leads to reduced call volume, quicker issue resolution, and better resource allocation in the call center, ultimately improving member experience and reducing costs.
5. Optimizing Care Outcomes through Coordinated Care
A 360-degree view of a member’s health allows the payer to provide more effective care coordination across multiple providers and settings. Inefficiencies and mistakes that arise when different providers aren’t equipped with the same patient data can be reduced drastically in this way.
A member who visits several specialists for a chronic condition could receive a tailored care plan that ensures coordinated treatments and reduces gaps in care (e.g., avoiding duplicate tests or conflicting medications).
Better care coordination through a Member 360 approach thus leads to improved clinical outcomes, reduces hospital readmissions, and lowers unnecessary healthcare spending.
6. Next Best Actions for Members: Personalized Recommendations
Based on comprehensive data, payers can recommend the “next best actions” for each member, such as which doctor to see next, which health programs to join, or lifestyle changes to consider. Giving direct and highly-structured recommendations in this way gives members clarity and peace of mind, as well as access to healthcare practices that may not have been obvious or accessible to them otherwise.
A member with hypertension could be recommended a specific cardiologist, a wellness program focused on managing blood pressure, or a smoking cessation initiative.
Encouraging members to take the right steps in their healthcare journey ensures more proactive care, better health outcomes, and increased member satisfaction.
7. Increased Care Management
A holistic approach allows for deeper insights into each member’s needs, enabling more tailored and frequent care management outreach, especially for high-risk individuals. Members who deal with serious or chronic conditions cannot afford to have their healthcare journey mismanaged, and with a Member 360 approach, inefficiencies and suboptimal treatment plans can be avoided.
For example, members with complex, multi-condition health needs can be paired with dedicated care managers who use the 360 view to personalize their care plan and provide continuous support.
Enhanced care management reduces hospital readmissions, improves chronic condition management, and promotes member engagement with their care plan. These outcomes serve both the payer and the member by leveraging the data synthesis made possible by the Member 360 approach.
Deliver Innovative Care and Robust ROI with Member 360
The Member 360 approach offers a rare opportunity to implement changes that serve both the payer and their members. After all, better care means happier, healthier members as well as lower costs for payers, and that’s exactly what the Member 360 strategy delivers, by leveraging the very best tools and functions available in the modern data space.
At Hakkoda, our Snowflake and AWS data experts have deep industry knowledge and experience with integrating the 360 approach from all sides of the healthcare journey. Our approach consulting ensures you’re not only equipped with the data tools and architecture you need to thrive but also the training and long-term support to adapt and grow as an organization alongside your data stack.
Ready to build a modern, data-powered foundation for better care? Reach out today to learn how we can help you implement a Member 360 strategy that transforms both member experiences and business performance.
