6 Tips to Avoid Being a Monday Morning Quarterback

The following is a shared post from our new parent company, Welltok, based in Denver, CO.  Click here to follow the Welltok Blog


As a company that has developed an award-winning consumer engagement platform, and now shares our hometown with the Super Bowl 50 champions, the Denver Broncos, we know how to score a touchdown with consumers.

Here are 6 tips from Silverlink’s VP of Engagement Sciences, Kathleen Ellmore, to make sure you don’t wind up playing Monday morning quarterback like the Panthers – looking back at what plays you should have run differently.

Don’t miss this Wednesday’s webinar on how Welltok and Silverlink (the newest company to join the Welltok family) can help make sure your consumer engagement playbook is on point to engage consumers the right way, at the right time – click to learn more and register.

1. Capture program engagement data at the individual level. Then, use that information to design even more personalized and relevant programs for members. One Northwest insurer used data to help identify consumers for a medication adherence program, by understanding who would be most receptive to their efforts.

2. Collect member preferences and then use them. If a member prefers to be contacted by email, mail, phone, text, etc., make sure you honor that preference. A four year study recently published by Kaiser found that members with a chronic condition prefer their first contact with their doctor be via email.

3. Target members on topics that are relevant to them. For example, don’t send a screening reminder if that screening already took place. Recently the Boston Globe reported on a 6 year old who was asked by her health plan to stop smoking to “better manage her chronic obstructive pulmonary disease. She does not have that disease. Nor, of course, does she smoke.”

4. Run A/B tests to find out if consumers react better to a gentle nudge or a sharp directive. This particularly works well when it comes to unpleasant, but necessary tests, like a mammogram or a colorectal screening. Insights from Silverlink, a Welltok company, shows that adopting the rigor and discipline of regular A/B testing provides deep consumer insights that will allow you to significantly improve your engagement.

5. Analyze call disposition data from your call center. If a consumer has three or more unhappy experiences, proactively reach out to ensure their issues are resolved. Showing you care enough to take the extra step can make a big difference in that consumer’s satisfaction. A great example is United’s Advocate4Me program, which provides consumers with a single point of contact for the duration of any problem, and empowers that contact to provide the help needed to promote a satisfying experience.

6. Start by understanding what consumers think of you. Execute a consumer satisfaction survey and be prepared to act on it. Then, measure again half way through the plan’s calendar year. This midpoint pulse helps you both understand how you are trending, but also highlights members who may be a flight risk at re-enrollment.



Health Literacy – Finding The Best Words for Better Health Engagement

By Andrea Powers, RN, BSN, MS, Director, Healthcare Solutions

The month of October celebrates many health awareness events: breast cancer, Down Syndrome, and Autism are just a few of those.  Another awareness that the month brings is Health Literacy, and as October comes to a close, it’s important to bring awareness to this and other important health topics year round, not just for one month out of the year.

Health Literacy is the ability of healthcare consumers to understand and act upon health information and services they need to make appropriate health decisions. But a significant gap exists between the way healthcare information is communicated and the ability of most people to understand those communications. In the post ACA environment, engaging consumers in their healthcare is more important than ever, yet when it comes to communicating with these consumers, we are not using terms or language that they understand. If they don’t understand the information we are sending them, how can we engage them?

About half of all Americans, approximately 90 million people, have difficulty understanding health information. As a nurse, I have spent much of my career teaching patients about their diagnoses, their medications, and their treatment plans. But I remember receiving a valuable teaching moment from one of my patients. While trying to explain what happened to him after having a heart attack, he looked at me and said, “Lady, just talk to me in plain English please.”

So being conscious of the consumers ability to understand industry “jargon” is important, especially when one out of five American adults reads at the 5th grade level or below, and the average American reads at the 8th to 9th grade level. Yet despite this, most healthcare materials are written above the 10th grade level, which means we are leaving a large portion of healthcare consumers at risk for miscommunication and additional health issues.

The positive aspect is that there are multiple initiatives in place to create change in how we deliver information to consumers. The Department of Health and Human Services (HHS) and the Center for Disease Control and Prevention (CDC) are just two of the government organizations promoting health literacy. At Silverlink, one of the tools we rely upon to achieve health literacy is the Plain Language Guidelines and Thesaurus. Plain language is a strategy for making written and oral information easier to understand; and it is communication that users can understand the first time they read or hear it. Key elements of deploying a plain language communications strategy include:

  • Organizing information so that the most important points come first
  • Breaking complex information into understandable, smaller chunks
  • Use of simple language and defining technical terms
  • Use of the active voice

But healthcare professionals still need to consider the fact that language is also influenced by culture, education, and even the region you live in, so “plain language” to one person may not be as plain and simple to another. This is why it’s also important to know who your audience.

At Silverlink, our creative team is attentive to adapting the use of plain language to accommodate both cultural sensitivities and health literacy with every outreach campaign they develop. We use communications designers, health communications experts, and professional script writers to develop content that is targeted toward specific member populations. Whether it’s supporting literacy at the 4th grade level for some Medicaid populations, or accommodating literacy at the 6th-8th grade level for many commercial populations, Silverlink strives to deliver health communications for our clients that will provide the highest potential for better engagement.

The good news is that it’s not just the team at Silverlink that is trying to improve health literacy. Healthcare facilities everywhere are trying to do the same because using plain language is the best strategy for making health information easier to understand. And when healthcare consumers understand their health, they will take more actions to improve their health.

Still Miles to Go: Addressing Disparities in Healthcare

By Sarah Baker, Manager, Population Health

The Quality Improvement Project Plan (QIP) deadline is approaching fast for Medicare Advantage plans, and that means they need to start focusing on one of the nine conditions released by CMS, and start improving care while reducing disparities.

CMS is concerned about the ethnic, geographic, and socioeconomic challenges faced by many Medicare Advantage members, and they should be. Here are just a few reasons why:

  • Among older adults diagnosed with depression, 73% of Caucasians received treatment, while just 60% of African-Americans and 63% of Hispanics received treatment.
  • Improving access to care improves colorectal cancer screening rates, but minority populations continue to be screened at lower rates. Additionally, rural residents are less likely than urban residents to be screened for colorectal cancer.
  • African-Americans are four times less likely than Caucasians to receive treatment for Parkinson’s.

There’s no doubt that these disparities are caused by a complex set of factors, but clearly the healthcare community is failing to connect with, and adequately communicate to, patients using interventions that are relevant and timely.

disparities_blog (2)

Creating tailored interventions can be difficult, not to mention costly, but by using our proven “test and learn” methodologies, we have helped reduce disparities in outcomes for many of our health plan clients. We’ve also improved the effectiveness of communications for clients via message segmentation. For example, through IVR programs we discovered that Hispanic men respond better to male voices while African-American men respond better to female voices; and that using ethnic-framed messaging is more effective in Hispanic audiences than non-Hispanic audiences.

But delivering important health-related information through relevant communication channels is also critical. For instance, we found that women are most likely to engage via IVR, while men, even those that have engaged with IVR, are more responsive when receiving a follow up call; and independent research showed that Hispanics text 1.56 times more than Caucasians, and African-Americans text 2.25 times more than Caucasians.1

By applying tailored and relevant outreach to Medicare Advantage populations, there is significant potential for health plans to increase engagement, improve care, and reduce disparities while meeting CMS requirements for QIP.

1Using Health Text Messages to Improve Consumer Health Knowledge, Behaviors, and Outcomes. U.S. Department of Health and Human Services Web site. http://www.hrsa.gov/healthit/txt4tots/environmentalscan.pdf Published May 2014.

Engaging The Unengaged Health Plan Member

teaserbox_2454704617For anyone working in healthcare today, engaging consumers in their health is one of the single most important goals. Health plan members who have a stake in the quality of their healthcare are key in getting better outcomes, lowering costs, and seeing fewer visits to the ER.

It’s easy to spot an engaged member. He or she does what the healthcare provider says they should do to achieve the best health outcome. They are the folks who are using fitness apps and wearing a Fitbit. Before they wore a Fitbit, they were a frequent flyer at WebMD, before there was WebMD, they had a copy of the Merck Manual at their house. There have always been engaged members or patients and they’ve always found a way to access information about managing their health. Health plans want to support these positive behaviors and many are making investments in encouraging those behaviors in the category of “wellness.” But most will admit that the driver for these investments is not reducing healthcare expenses.

Focusing on the already engaged member almost never can. Subsidized gym memberships serve as a simple example. Our health plan offers a $150 subsidy for gym memberships. Since incentives need to be made generally available, we offer that to all employees. And obviously everyone who has a gym membership happily accepts the benefit, with zero change in behavior – after all they belonged to the gym before the benefit. If 60 people of 100 already belong to a gym and 2 actually join a health club who didn’t belong previously (let’s ignore that gyms in our area are at least $500/year), then I’m changing behavior. But that behavior change came at a high cost ($150 X (say) 60 +2 employees or $9,300). So I paid $4,650 each to get those 2 employees to join the health club.   So while these investments may pay off in areas like retention, which are increasingly important and valuable to health plans (see our brief on the value of the engaged member), they typically can’t be justified on the basis of healthcare cost ROI.

So where can engagement materially change the cost curve? When engagement is focused on the un-engaged member or patient. To simplify, this group can be further broken into two sub-groups, the “unwilling,” and what I refer to as the “willing and unable.” Since the unwilling are highly resistant to change by definition, the most potential for meaningful behavior change is this second sub-group.  This is a fairly large, diverse group, if we define it as those “unable” with respect to appropriate or preventive health behaviors. The group includes the 51 year old who doesn’t know when his next colonoscopy has to happen, the Medicaid mom who doesn’t know where she can get her young child immunized, and the Medicare beneficiary who forgot to refill her meds.

The good news is these folks are relatively easy to identify, and a significant portion is willing to change their behavior if presented with the right information, in the right way, at the right time. The other news is that if you build it, these folks won’t come. We can’t count on them to exhibit the information seeking behaviors that the “willing and able” do. We need to proactively serve up information to these populations – specific and timely information – to activate them. But the other good news is that this group can be influenced and targeted efforts can have a very positive impact on behavior and healthcare cost.

The key is technology. Technology can help you identify these individuals, and can drive behavior change through proactive omni-channel interventions to meet the different learning and communication styles of the hard to engage population. Technology can help health plans reach and educate these members through personalized, relevant, and targeted outreach. At the end of the day health plans understand that the need to meet individuals where they are on their health journey isn’t a trend, it’s a reality. Organizations that can use technology to “enable” the “willing but unable” will truly begin to move the needle in improving outcomes and reducing costs.

Summer, Sand, Sunshine, and…..Flu?

By Andrea Powers, RN, BSN, MS, Director, Healthcare Solutions

For those of us living in the Northeast, summer couldn’t come fast enough this year. And now that the calendar has turned to August, we are savoring every minute of time we have to enjoy beaches, barbecues, and bonfires before the days start getting shorter. But as a healthcare professional, there’s another thing that August represents for me: time to start thinking about the upcoming flu season. Why? Because flu is not something we should start thinking about once the season is upon us and a family member or coworker becomes sick.

flu image

But there’s a challenge in convincing people of the importance of flu shots because many have an underlying belief that they’re not effective. Unfortunately, the 2014 Influenza vaccine was a mismatch for the viruses that were most prevalent and as a result, the Center for Disease Control (CDC) reported the highest rate of senior flu hospitalizations in 10 years. Even though we know that the flu vaccine can work, we also know that it can vary in terms of effectiveness due to a number of factors, including age, health, immune status, and the similarity between circulating influenza viruses and vaccine viruses. All of these impact how effective a vaccine will be for one individual.

Not only can the flu shot protect you, it can also protect others around you like family, friends, and coworkers. The flu is a serious illness that can lead to hospitalization and even death. In fact, the death rate from last year’s flu season was 6.7%, just under the 6.9% threshold that is considered epidemic levels.

When you take all of this into consideration, healthcare organizations and providers should be promoting the benefits of getting a flu vaccine for 2015-2016 now while simultaneously addressing the reasons or barriers for not getting a flu vaccine. Many of our clients are already asking what they can do differently to convince people of the importance of receiving a flu shot.

One strategy we suggest is a campaign to educate and address the reasons or excuses many members may use for not getting the vaccine―It doesn’t work, look at what happened last year, I’m healthy, I don’t need it, the flu shot gives you the flu, and so on.

A well thought out approach and timely outreach to provide accurate information to consumers can counter balance those excuses and go a long way in educating people that the single best way to protect against the flu is to get an annual vaccine. And the education should go beyond the barriers or excuses to include good health habits like proper hand washing, covering your mouth when sneezing, and staying home when you are sick.

The CDC and the Advisory Committee on Immunization Practices (ACIP) recommend flu shots for seasonal influenza as soon as the vaccine for that year becomes available, usually by October. So start promoting it early, address the barriers, educate on healthy habits, and tell your members “roll up your sleeve!”

CAHPS: How To Be A Satisfaction Star

By Sarah Baker, Manager, Population Health

The 2015 CAHPS surveys are in, so now what? Are your results what you thought they’d be, or are you mystified by another year of apparently unpredictable member opinion?


Looking back through the past few years of Medicare Advantage Star rating satisfactions measures, we see that improvement has been difficult to achieve despite impressive improvement in other measures. From 2012 to 2015, the national average for Colorectal Cancer Screening increased from 53% to 65%; Flu Vaccine increased from 68% to 73%; and even the much-dreaded Osteoporosis Management After a Fracture, improved from 20% to 27%. But satisfaction, although rated 1.5, has been flat, which begs the question is it really easier to convince a member to have a colonoscopy than it is to get them to love their health plan?

We don’t think so. Most of the clinical measures, cancer screenings, diabetes care, even readmissions all have a clearly defined target population, and we know what action members need to take to be successful. While not always easy, there is no question about what needs to be done and that has made them more attractive targets for improvement versus attempting to change the opinions of seemingly capricious members. But they are not as fickle as they may seem, and with CAHPS survey results in hand, now is the time to develop your organization’s plan for improving member satisfaction.

Plans that are successful at driving improvement start by breaking down their processes, and then optimizing each one of them. The only way to do this is to ask members what they think, and ask them often. Most of our client plans have moved beyond the annual CAHPS sample to more frequent satisfaction surveys, and technology makes this easy. Integrated Voice Response (IVR), text, and web surveys have significantly reduced the cost of what was once a very expensive endeavor. An added benefit is that health plans will get points for asking because members will feel that their plan cares about what they think.

But with information comes responsibility. If health plans are asking members for feedback, they need to be prepared to acknowledge, affirm, and act on it.  They need to acknowledge that they heard it, affirm that they appreciate members taking the time to provide input, and they need to let the members know that although the health plan may not always be able to solve something in the manner the member prefers, they are prepared to act on their feedback.

Have you ever made an online purchase through a brand’s website and right after clicking “submit order” you see a survey pop-up asking you to rate your online purchasing experience? Health plans need to do the same thing. Ask your members about their experience after they’ve had an encounter with the healthcare system. These short surveys can provide invaluable information – Were you happy with the care you received? Would you recommend this provider to other members? Negative replies will be flagged for customer service follow-up and the aggregate responses will allow you to plant red flags in your customer journey map and the processes that correspond with those customer touch-points.

These same technology tools can be used to create member advisory boards, focus groups, and tele-Town Halls, which and are invaluable sources of insight into member attitudes and expectations.

Many plans with top satisfaction scores, such as Martin’s Point and Tufts Health Plan, are also award-winning employers. They are well known for being fanatical about their work culture because they know that if their employees don’t engage, neither will their members. This is backed by recent research that found that employee attitudes drive business performance. This focus on satisfaction has even led to a new role at many organizations – the customer experience officer. These individuals are challenged to create customer-centric cultures where each department’s mission is to put the member first.

While it may seem daunting, CAHPS improvement is possible. Take a closer look at your processes, break them down, evaluate them, and find ways to improve them. Communicate with your members and ask them what they think. Are they happy with their plan? Are they happy with their health care? How can we make it better? Then Implement those changes. Then keep asking.

As the health plan world continues its transformation from a B2B business model to a new model that puts the member squarely in the driver’s seat, the focus on engaging and satisfying today’s healthcare consumers is paramount. Using these best practices, in combination with technology, health plans can deliver an enhanced consumer experience. And having partnered with our clients to achieve this, we know that enhanced consumer experience leads to improved member satisfaction.

We’re not moving fast enough and we’re still not understandable

By Ingrid Lindberg, Chief Experience Officer, Chief Customer, LLC


After AHIP 2015, I was ruminating a bit about the pace of change in health care. My impatience with the speed of change in this industry was driving me nuts for a few days. Then, like always, it snuck back to the corners of my brain to be forgotten as more important things took over.

Until this morning. This morning, I woke up and checked Facebook. Like so many people do. Facebook is now offering the “day in the life” version of what happened to you in your Facebook lifetime on this day?

One of my highlights was that a friend posted a note about me being featured in this article circa 2014, post AHIP. The title was: “Payers Make Consumers Their Focal Point”. The article was all about consumer needs and expectations and how all the payers were doing all these things to meet them. A year and another AHIP later, I call baloney. Same topics. Same challenges. Very little movement.

It got me thinking. How many articles could I find, going back how many years, where I’ve been saying: “It is the age of the consumer in health care! Now is the time to make change! We can all simplify and make communicating better for our members/customers/consumers!”? The answer? Well over 500 since 2007.

We are simply not actually ACTING. We’re talking, but the industry is not RESPONDING.

People want us to speak clearly. People want to actually understand what they are buying. People want to hear from us a maximum of once a month – and that message had better be salient and interesting.

Think about a consumer’s brain.

. consumer_brain

Where on earth do you think they have room for you?

The answer is – when you get a glimmer of interest.. a second of their time, you’d best be using it to your advantage. Stop bombarding people with all the messages YOU want to send them. Take the time to figure out what people want to hear about from you. I hate to tell you, but every single person is different, and if you want to engage with them, you’ll have to identify how each of them ticks! There are three tips to start with that I give every person in health care who is trying to communicate with a consumer:

  1. Speak in plain language. If it isn’t written in 5th grade language, the chances your message will be comprehended go down significantly.
  2. Make sure your message is relevant to me. Don’t send a note about an annual physical when I’ve just had it. Don’t blast me with offers for all of your free and cool apps and services if you have denied one of my claims.
  3. Do it based on my preference. I, personally, will never, ever pick up the phone. Especially when the phone number isn’t one I recognize (or shows up as unavailable). My mother on the other hand, LOVES the phone. (She’s still using a 10 year old flip phone for her cell and if you recall how hard it is to text on those…) Moral of the story: if I tell you never to send me another piece of paper, just don’t do it. It is disrespectful and certain to land in the shredder – and it shows me that you simply aren’t listening. If you aren’t listening to me, I’m surely not going to listen to, or engage, with you.

I know you can’t do it over night, but you can do it step by step. Start small. Rewrite your most used pieces. Then test them with your grandparents or your barber. Then try again.

We can become easier to understand and thus, easier to work with.We can make a difference – and if we don’t act now, we’re in a whole heap of trouble. If 75% of millennials don’t understand the term “co-insurance” – imagine how difficult it will be to gain their trust to engage them when the time comes.

About Ingrid Lindberg

Ingrid Lindberg is a serial CXO. As one of the first CXOs in the country, she has been on the leading edge of customer experience for over 20 years. She’s partnered with and been employed by and consulted with numerous Fortune500 companies across Finance, Healthcare, Packaged Goods and Retail, working with them to create differentiating customer experience strategies and cultures.  Follow @iclindberg on Twitter.

Key Takeaway from AHIP: Be Disruptive!

AHIP Institute 2015

At last week’s AHIP Institute we had a numerologist in our booth – for fun and to attract visitors – but also because there was a connection between numbers and a significant new capability of our EngageME 2.0 member engagement software: engagement scoring. My Destiny Number was a six, which apparently is one of the worst Destiny Numbers you can have. So that’s not good, but I’ve never been one to believe I can’t alter my destiny.

I’ve been thinking about that as I listen to health plans talk about how they want to change their destiny. They want to transform from claims processors and gate-keepers to trusted guides for consumers. That’s a pretty trans-formative change, yet many want to get there incrementally, and why not? Getting there incrementally has less risk, doesn’t break glass, and doesn’t require changing people’s jobs or compensation. But this is a big change, and you’ve got to wonder whether big change can happen by health plans taking small steps. In this industry it sometimes feels like it takes an act of Congress to drive big changes. I would argue that we need to be disruptive to create the needed change, and that small steps are the enemy of disruption.  It provides the illusion of progress and keeps the disruptors at bay: “we’re getting there, we just have to be patient.”

There were genuine disruptors in evidence at AHIP. Arguably one of the most successful contemporary disruptors is Elizabeth Holmes, CEO of Theranos. Holmes and her mission to upend medical testing is not only disrupting the clinical lab testing industry, it’s revolutionizing it. Theranos’ goal to make lab testing more accessible and the data more transparent to consumers is creating so much disruption that if they succeed, they could put much of the current lab industry out of business. She is in the process of disrupting a multi-billion dollar industry and she’s doing it very successfully!

Another disruptive force in healthcare that’s closer to home is Ingrid Lindberg. Ingrid is a good friend who pioneered the concept of customer experience in the healthcare industry. From her experience at American Express, Cigna, and Prime Therapeutics, Ingrid has built world class customer experience departments and is recognized nationally as the leading expert in her field. And she did it as a process disruptor. I don’t think she’d know what swimming downstream even looks like. She changed compensation plans within her organizations, interrupted the existing processes, and re-defined company missions. She’ll be the first to credit strong executive support for her success, but she doesn’t have a lot of patience for those who want to get there incrementally.

And I agree with her. Consumer engagement isn’t pediatric cardiac surgery, we can try something different. As an industry, healthcare still has a long way to go to transform into ‘trusted guides’ for consumers. It’s time to take some risks, it’s time to be disruptive. The rule of disruption is that over time you either disrupt yourself or someone else will do you the favor.

And the disruptors are coming! I hope to hear from many of them at AHIP Institute 2016 in Las Vegas.

COB and Healthcare Payment Integrity

By Monique Pierce, Cost Containment and Coordination of Benefits Expert

M Pierce

Over the last 15 years, I have been fortunate to share my expertise in COB and Payment Integrity with co-workers and industry colleagues.  Today, with the implementation of the Affordable Care Act, the conversation around the need for effective COB programs and strategies is getting louder. With new eligibility rules and expanded coverage, health plans are facing a host of new challenges such as reassessing cost containment and payment integrity programs. Health plans today rely on reactive approaches to correct inappropriate medical expense payouts, a tactic that costs billions of wasted dollars annually. I spend a significant amount of time helping plans solve this problem.

Here are a few examples of why health plans should have a strategy around payment integrity, and especially Coordination of Benefits.

  1. True Alignment– Unlike other compliance and operational processes, a strong preventive COB program benefits all stakeholders, not just the Health Plan or Provider.   Employer Groups benefit from accurate cost sharing, whether they are fully insured or self-funded, and the member benefits financially from the accurate application of their dual benefits.
  2. The Data Challenge – Data is both the problem and the solution. When operational systems are not able to collect, verify, and validate data about other coverage on all members, claims are incorrectly paid. The cost to prevent all inappropriate payments is high. The challenge is to use analytical scoring models to determine the set of members on which to focus in order to provide the greatest ROI.
  3. The Financial Opportunities – Large dollars get everyone’s attention. COB is a top cost containment opportunity for health plans.  It’s easier to get budget approval for process improvements and system enhancements when you can show a strong ROI.

The bottom line is that it’s never been more important to evaluate existing cost containment efforts.  For health plans to maximize their budget dollars, a transition from traditional postpaid recovery to a preventive approach to COB should be an active agenda item for 2016 planning.  If you would like to learn more about the role technology is playing to solve the COB challenge, this white paper might help. “Coordination of Benefits: Applying a Prevention Strategy.”

About the Author

Monique Pierce is an industry subject matter expert in Cost Containment and Coordination of Benefits. She has been responsible for development and implementation of technical and operational solutions in the healthcare industry for over 15 years. Ms. Pierce has worked for national and regional health plans, as managing partner of a consulting firm, and is currently employed by a leading healthcare analytics company developing pre-payment cost avoidance programs. Monique can be reached by email at mpierce@1980partners.com.

Baseball, Healthcare, and Medication Therapy Management (MTM)

By Brand Newland, PharmD, MBA, Vice President, OutcomesMTM


Former baseball player and oft-quoted communication legend, Yogi Berra, once said, “It’s tough to make predictions, especially about the future.” On occasion, however, the past can provide an insightful look into what the future has in store.

In healthcare, face-to-face relationships were once the foundation on which the system was built. With care primarily a local endeavor, patients went to see their doctors, and doctors came to them. According to the American Academy of Family Physicians, in the 1930s, physician house calls accounted for 40% of medical visits. By the 1980s, house calls accounted for just 1% of visits.

In recent decades, new technologies and a drive for efficiency have whittled away some of the personal interactions of healthcare. In pharmacies, robots have made the dispensing of medications exceptionally efficient and safe. This led to large, busy pharmacies; prescriptions by mail; and other convenience options for consumers. But these efficiency and technology advancements come at the expense of what, for some patients, could have been valuable interactions with a healthcare professional.

Recent trends point to a swing back to personalized care supported by technology. Examples of this intersection of the old and new:

  • Telemedicine
  • Concierge medicine
  • And, you guessed it, even house calls by nurses and other healthcare professionals who come armed with advanced clinical support software loaded to tablet computers

Pharmacy is no exception. Local pharmacists are taking on an increasingly clinical role through the delivery of Medication Therapy Management (MTM) services. These services, required under Medicare and expanding to other areas, are designed to help patients avoid and resolve problems with their medicines.

This recent example illustrates the value of MTM:

During a Comprehensive Medication Review, the participating local pharmacist noticed the patient’s blood pressure medication did not align with current clinical guidelines. The pharmacist decided to check the patient’s blood pressure. After obtaining two elevated readings, the pharmacist contacted the patient’s physician to recommend a different medication. As a result of the consultation, the prescriber agreed with the recommendation, putting the patient on the path for better blood pressure control and overall health.

Comprehensive Medication Reviews, or CMRs, hold great potential to improve patient care. In fact, the Centers for Medicare and Medicaid Services (CMS) have recently announced CMR Completion Rate will become a Star Rating measure for the 2016 plan ratings. The message is clear—more patients need CMRs.

OutcomesMTM manages a national network of local pharmacists who deliver CMRs and other MTM services. We count on our network pharmacists to offer the CMR service to eligible patients and explain its benefits. Two years ago, we started working with Silverlink Communications to add a splash of technology to support this “old-fashioned” healthcare interaction. By deploying Silverlink’s engagement solutions, members of many of our health plan clients now not only receive an offer from their local pharmacist but also receive letters and phone calls via an integrated communications strategy. And, like elsewhere in healthcare, the combined approach is yielding great results.

  • In 2014, health plans utilizing this combined approach experienced 70% higher CMR Completion Rates than health plans that did not

What once was old is new again in healthcare…with a technological twist that promises to improve the patient’s experience and overall care. To quote another Yogi-ism, “the future ain’t what it used to be,” but in this case the future seems to be returning right back to where it came from.

About Brand Newland.

As Vice President of Business Development, Brand guides OutcomesMTM’s Sales, Client Services and Government
Relations initiatives to further the Face-to-Face Difference®. As he is responsible for both Sales and Client Services,
smooth implementation—as well as consistency in sales messaging and client experience—are key priorities. His
goal is to see excited sales prospects become engaged and enthusiastic clients. Brand can be reached by email at bnewland@outcomesmtm.com.