The Member 360 approach is an innovative data strategy used by medical insurance payers in order to synthesize a wide array of member data with the aim of driving better healthcare outcomes and bolstering their bottom line.
This strategy involves 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.
In a recent article, we discussed how organizations can use this model to implement transformative data practices, ranging from advanced risk analysis and predictive modeling to various forms of preventative outreach that empower members, improve quality of care, and produce better healthcare outcomes.
Clearly, these data capabilities have the potential to transform the payer-member relationship for the better, but this strategy wouldn’t be possible without the modern data stack, backed by thoughtful data strategies that get the most out of the tools and functions of that data stack.
In this article, we’ll discuss some of the challenges that organizations face in adopting the Member 360 strategy and the solutions innovators are using to overcome these challenges. We’ll also discuss a pair of real world examples of organizations that achieved staggering results by adopting this approach.
Implementing the Member 360 Approach: Six Key Challenges and Solutions
1. Data Integration and Management
Challenge: To achieve the Member 360 approach, all member data, including clinical, claims, behavioral, and social factors, should be integrated into one centralized platform that is accessible across departments. After all, data cannot be synthesized if it is segregated across multiple siloes.
Strategy: The obvious solution is to implement advanced technologies such as cloud-based platforms, AI, and machine learning to capture, store, and analyze data efficiently. Unified data is the fundamental promise of the modern data stack, and these tools are specifically designed to provide that means for total data centralization.
2. Utilizing Predictive Analytics and AI
Challenge: With the right data architecture, advanced data analytics can be leveraged in order to predict future health risks, potential claims costs, and care needs, allowing payers to take preventative actions. Achieving this isn’t as simple as simply centralizing member data; the data actually needs to be efficiently analyzed to produce actionable insights.
Strategy: Leveraging AI to guide decision-making processes for both payers and members, identifying high-risk members, recommending targeted care actions, and automating alerts for care teams.
3. Cross-Department Collaboration
Challenge: The Member 360 approach requires that payer organizations ensure that all departments—clinical, customer service, operations, and IT—actually work together to deliver a unified experience for members. Data centralization makes this sort of synergy possible, but cooperation across organizational teams is required to actually make it work in practice.
Strategy: Organizations should strive to maintain regular communication and shared goals to ensure that every department has access to the same member data and is aligned on delivering tailored care interventions.
4. Engaging with Third-Party Partners
Challenge: Full data synthesis does not end with internal data. It’s crucial for payer organizations who want to implement the Member 360 approach to collaborate with third-party health tech vendors, wellness program providers, or social services organizations to extend the payer’s reach and offer comprehensive solutions to members.
Solution: Organizations will need to work to integrate wearable devices, telehealth services, and community resources to address both clinical and non-clinical aspects of health.
5. Data Privacy and Security
Challenge: Naturally, one of the major challenges of a unified data approach for medical insurance payers will be managing sensitive health data while ensuring compliance with HIPAA and other regulations. Data privacy and security is of utmost importance for payers, with any missteps potentially leading to compromised member data and costly damages to their brand and bottom line.
Solution: The solution here is fully technical: well-designed architecture ensures greater data safety and privacy. A Member 360 approach will involve robust encryption methods, secure data access controls, and regular audits to ensure member data is protected.
6. Data Quality and Consistency
Challenge: For the Member 360 approach to produce truly transformative data synthesis, data accuracy and consistency across multiple sources has to be ensured. Data has to be up-to-date and fully accordant at all levels or else the data cannot be effectively utilized.
Solution: Organizations will need to implement strong data governance policies and regular data cleansing as they implement the Member 360 approach. These features should be strategically built into the organization’s data architecture.
Two Organizations that Produced Striking Results with the Member 360 Approach
Case Study 1: High-Risk Care Management
One payer implemented a Member 360 approach for several self-funded jumbo groups, identifying high-risk members through predictive analytics. By coupling care managers to high-risk individuals to more effectively manage and more frequent follow-ups, they increased revenues by $30M.
This not only was an increase for the payer in revenue, but the jumbo accounts who purchased a managing nurse for every 5, 10, etc. number of members, also saw greater engagement from those members in programs and lower costs compared to similar cohorts. This sort of preventative intervention could only have been achieved by synthesizing quality data and leveraging AI tools to analyze that data for predictive insights and acting on the findings at the member level.
Case Study 2: Improving Personalized Engagement
A health insurer used the Member 360 strategy to coordinate with a CRM tool and bring many sources together to deliver a medically focused dashboard to customer service agents to personalize communication and care programs based on social and health data available at the individual member level.
Through a synthesized data approach, payers can more effectively communicate with members and thus ensure better healthcare outcomes. This leads to a more productive payer-member relationship and high member satisfaction, which leads to increased member retention.
Driving Outcomes and Operational Efficiency with the Member 360 Approach
The Member 360 approach leads to enhanced member engagement, improved care coordination, better outcomes, and cost optimization, but implementing this strategy requires vision, organizational coordination, and a robust data stack that can facilitate data synthesis.
At Hakkoda, an IBM Company, we leverage our expertise in Snowflake and AWS together with deep HCLS experience to help medical payers build the data stack that will allow them to innovate and thrive according to their needs and goals.
Our approach to consulting is holistic and deep; we take our clients from the planning and design stages beyond the ultimate implementation phase, providing training to our client’s internal data teams and responsive collaboration to ensure long-term success.
If you’re ready to drive better healthcare outcomes for your members and bolster your organization’s bottom line in one fell swoop, let’s talk today.
