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White Paper

Partnering to Enhance the Member Experience

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You can’t avoid the buzzword of payer-provider collaboration these days, but what does it really mean in practice, and how are organizations making progress? What actionable areas should payers and providers focus on as they create and implement strategies to deepen collaboration? These questions have increased in importance as we contend with healthcare staff shortages, the rising cost of care, and new transparency mandates—all of which are compelling reasons for plans and providers to work together. These important industry partnerships can serve to improve data accuracy, streamline business operations, and, ultimately, provide a better member experience.

67% of plan execs want to collaborate with providers more in 2023 to realize benefits like improving member experience, driving business growth, and improving population health.

Impactful Partnerships Hinge on Overcoming Data Challenges

Data lies at the heart of the challenge—and the opportunity at hand. Tracking and maintaining accurate provider data is a complex process. Plans have thousands of providers to manage and support, and getting information is no easy task. Recent requirements around provider profile accuracy and attestation also place a huge burden on providers, who in 2021 already “reported spending on average 15.6 hours per week on paperwork and other administrative tasks.” But when provider data is inaccurate, it erodes people’s trust in the provider and the plan.

“This emergency medicine provider, Tyler, is in two systems, a male in one system and the other a female. Like, we don’t even have that level of data correct, right? So how can we ask our members or our consumers to trust that data?” – JEFF STEWART, Christus Health

4 in 10 consumers have found inaccurate doctor information on their health plan website

52.2% of Medicare Advantage provider directory locations have at least one inaccuracy.

Regulations Are Not Enough to Help Patients Navigate Care

Health plan execs say improving data accuracy and bringing member out-of-pocket cost information into provider workflows are top actionable areas of collaboration for 2023.6 Mandates and legislation, including the No Surprises Act, are forcing collaboration to the forefront. In order to truly improve the member journey, plans and providers need to build meaningful experiences that help patients navigate an ever-increasing complexity of information.

57% of health plan executives are thinking strategically to leverage the mandate to add new experiences for members.

CAHPS and Medicare Star Ratings

Inaccurate provider data can have a significant impact on CAHPS scores, which are an important performance measure of the Medicare Advantage Star program. With the recent quadrupled- weighting, CAHPS scores now account for 32% of the overall Star Rating for 2023. These recent changes put an ever-greater importance on a health plan member’s perceptions of their provider directory experience.

“I don’t think any of us in this room would want to sign up to go show up at a hotel not knowing if there’s going to be a bed in my room and what am I going to pay at the end of the night, right. So why do we expect folks to be OK with that in healthcare?” – REETIKA KUMAR, Independence Blue Cross

Building Trust While Connecting Patients to the Right Providers

Trust is critical in healthcare. Consistent, accurate, rich data is what fuels trust—or erodes it. However, building trust is fraught with challenges, including inaccurate and incomplete information on health plans’ websites. Inaccurate provider data limits members’ ability to make informed decisions about their health, posing a significant barrier to care. Incomplete information can include things like languages spoken, treatment philosophy, gender, ethnicity, specialty, years in practice—critical determinants that patients use when selecting a provider they feel comfortable with.

“Because we’ve made healthcare so complex, we’re now in a place where it’s all driven by trust.” – REETIKA KUMAR, Independence Blue Cross

“We need to put the best data out there. How can we ask our members or consumers to trust that data when it doesn’t match in different systems? How do we start cleaning that data, and how do we make sure that data is the same across systems and plan sites?” – JEFF STEWART, Christus Health

Addressing the Barriers to Driving Better Consumer Experiences

A lot more can be done to make the healthcare system easier to navigate for all, and collaboration is at the heart of it all. Opening connections and breaking down silos of information between plans and providers can help lay a foundation for stronger relationships centered on a shared goal of reducing friction for patients and providers. Few people are thinking about the consumer experience when designing healthcare systems and apps. Consumers, however, have been informed by user-friendly apps like OpenTable, Waze, and Facebook to expect more. It’s no longer solely about making information available—it’s about making it delightful, but there are many internal barriers to making that delight happen.

“How do we get healthcare to actually start to think about consumer and member and patient experience in the same lens that all of us experience the rest of our digital world?” – JEFF STEWART, Christus Health

Putting It All Together: The Future of Collaboration

To create a more accurate and cohesive system—one that delivers a more connected experience and delights members – we need to start collaborating more systematically now. You’re in the ideal position to make a difference, but you don’t have to do it alone. Providers are eager to join forces to make healthcare better. Also, there are data management solutions that enable payer-provider collaboration, reconcile data through streamlined processes and power member portals with reliable provider profiles. Let’s make sure you are doing all you can today to guide your members to a great experience.

“We’re all in this boat together. Get together and talk about what’s working and what’s not.” – REETIKA KUMAR, Independence Blue Cross

Here’s what you can do now

1. Assess the gaps in your provider data

Do you have dated or inaccurate information, or is data missing altogether?

2. Devise a plan to update inaccurate or incomplete information

Build a repeatable process to capture provider attestation every 90 days. You may be able to solve this internally, but you may want to look for other solutions that can reliably handle this process without simply pulling bad data from other inaccurate sources.

3. Consider the member experience

Your process can’t stop at capturing up-to-date provider contact info. Ensure that you’re able to display it in a user-friendly way and that updates are made within the two business days required by the No Surprises Act. Accurate data is only beneficial if members can see it real time.

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