How Sourcing Can Change What Engagement Means in Healthcare

In the healthcare industry today there is a lot of talk about creating and improving “engagement.” Individuals taking more responsibility for their own health and care, healthcare providers connecting more proactively and consistently with patients, and health plans making it easier for members to utilize their insurance, just as a few examples.  One of the major points of engagement is shortly coming around for its annual “check up”—enrollment—when individuals in the U.S. are signing up for (another) year of health insurance. As people take more financial and individual responsibility for their health care expenses, this time of year is becoming a tangible reflection on how well a healthcare provider or plan is doing on “engaging” its constituents.

There are an increasing number of people enrolling directly as individuals for themselves or family versus through their employer.  Also, while the Affordable Care Act (ACA) extends healthcare options to individuals who may have been excluded in the past, it also penalizes individuals who choose to not enroll at all. Finally, when people enroll, they are sometimes finding out afterwards that their chosen plan does not include specific services, preferred physicians, or familiar prescriptions.  This can be costly for them, and lead to dissatisfaction and a desire to leave that plan or network.  In short, there are more people enrolling or re-enrolling who are unaware of options and financial support, creating an opportunity for healthcare organizations to set a new foundation for an on-going experience, and “engagement.”

Sutherland Healthcare Solutions has experienced the resulting questions and frustration from patients and healthcare providers first hand. As a service provider supporting customer service, billing and collections for healthcare organizations, Sutherland staffers are often manning the phones, receiving or making calls that uncover these issues after people are enrolled in plans and find out too late that their preferred doctor is out of network, for example, creating issues around access, claims, billing, and payments.

Going into the annual enrollment period last year, Sutherland worked with one of its healthcare provider clients to flip the focus from reacting to calls and questions after the healthcare service was provided, to proactively reach out and educate local constituents. The healthcare provider identified and segmented a population of people in its local area. Sutherland created a resourcing package to use multiple channels and approaches to connect personally with people via phone or email and offer to explain and, if interested, walk through the enrollment process and help navigate the options and the system.  It used its existing staff including financial counselors, and infrastructure.

In this case, the healthcare provider and Sutherland took a step back from the current process and results, and used design thinking to look at what the local community needed. They then mapped out a solution to be more proactive using insight and resources from both organizations. This approach is a change from the traditional service buyer-service provider BPO relationships, which were more directive relationships with the service provider focusing on execution. Sutherland tapped into its own experience in engaging with the clients’ customer base, and participated in the context design of a solution instead. We are seeing more and more examples of this type of more “intelligent engagement” as participants in the industry come together to solve its major problems more collaboratively.

Aligning and orienting their focus on the healthcare consumer is changing the nature and the value of the client-Sutherland engagement, as well the client’s engagement with local constituents. 

Healthcare providers entering the insurance market and health plans that are figuring out how to better connect with consumers, have an opportunity to leverage the experience and infrastructure of existing customer service providers to help address consumer experience and engagement. At HfS we see this willingness for increasing collaboration rooted in design thinking as a way to create a more healthcare-consumer oriented and engaged community.