COVID-19 has changed the playing field for health plans, pharmaceutical companies, and other healthcare organizations. As a response to COVID-19, the healthcare industry seemingly went digital overnight. The real question is: will digital healthcare live up to its promise? For that to happen, healthcare companies must accept that telemedicine and digital health technologies are no longer optional, but an integral part of the patient experience, both now and in the future. 


Investment in digital health and telemedicine presents an excellent opportunity to improve the patient experience, especially for those living with chronic conditions. According to a survey conducted by HCP Live, 65% of people with diabetes expressed they would like to continue with telemedicine after the pandemic. As many as 77% indicated that the quality of care with telemedicine, regardless of modality, was almost the same as in-person visits. On the provider side, 75% of endocrinologists indicated a desire to continue telehealth after the pandemic. Improving the care experience through digital health provides an avenue for reassuring members that health plans continue to their patients and their health outcomes. Additionally, in 2020 the Center for Medicare & Medicaid Services (CMS) has adjusted incentives to encourage health plan investment in an improved patient experience to lift member satisfaction, reduce the cost burden, and ultimately improve health outcomes.  


The convergence of increased adoption of digital healthcare technologies and restructuring of performance incentives has created a unique opportunity for health insurers. Top-performing health plans are strategically incorporating a patient-centric, digitized care network that improves member access, facilitates convenience of care, and empowers members to better manage their health. Health plans that are hesitant to strategically keep pace with their innovative competitors could find themselves in a precarious situation. Their members will look to switch to plans that better serve their needs through a more streamlined blended care model that improves their health and seamlessly fits into their daily lives. 


CAHPS  Quality Measures of Consumer Experience  

The financial impact of COVID-19 has driven people living with chronic conditions and comorbidities to defer care or not adhere to their care management plan. This will unfortunately have a lasting impact as people with chronic illness are likely to face potential compounding health complications for years to come. While this tsunami may hit down the road over an extended period of time, there are actions that health plans can take now to reduce its impact. 


The weighting for the 2021 CAHPS season (kicking off this spring) has quadrupled and now reflects 32% of the plan’s star rating. In the coming years, it’s likely that CMS will continue to place a sizable emphasis on member experience and either maintain the quadruple weighted status or increase it further. These surveys are designed to determine their experience with their health plan and their healthcare providers (such as home health care, hospitals, etc.). The aim of these statistically validated surveys, according to CMS, is to showcase what consumers perceive as the most important aspects of care. It is not just satisfaction, but their opinion on it. It is clear now that consumers value the convenience and effectiveness of digital health technologies and telemedicine. They are frustrated by the challenges with the traditional care delivery model and the severe delay in access to care. Laggard plans need to strategize now to keep up with their competition. The bar for member expectations keeps being raised and the competitive CAHPS benchmarks are only getting tougher. Those who continue with the status-quo approach will see their scores drop and their members switch to more progressive and patient-focused plans. Putting these strategies in place immediately is crucial, as these efforts take time to yield positive results. Most plans will not know the impact and yield from their current strategic action for 12-18 months, which means that health plans cannot afford to not take action now.  

Strategies to Improve Patient Experience  

Some best practices to improve patient experience and future STAR ratings include: 

1. Embrace customer data for insights

  • Carefully* and strategically run mock surveysdive deep into your banner tables, holistically assess customer service, and gather as much data as you can internallyEmbrace that data with an open lens. It will be key to understanding and identifying areas for improvement. Internal quality bandwidth is usually non-existent in Q1/Q2, so work with a consultant who specializes in this exact type of analysis who can interpret the data and offer a roadmap to optimize your strategy. You will be surprised what they can uncover and deliver in just a few weeks. 
  • Once you have a foundational understanding of where you are, you can use the data to identify the optimal solution for each member segment. Not all telehealth and virtual care solutions are created equal and the member segmentation is one of the most crucial components of an effective digital health strategy. Understanding your member sub-groups and aligning them to digital-first or human-centered solutions will optimize member care, as well as manage health plan spend. There is both a clinician and financial law of diminishing returns in play so answering the question of How deep and wide, should (and can) we send the net? is key.

2. Increase telehealth and virtual care

  • COVID-19 caused a major shift in healthcare delivery; the demand for virtual health increased by up to 300% during the pandemic and is not going to change soon. As COVID-19 concerns continue, health plans can use telehealth to make prescription pickup easier, reduce missed appointments, give more access to chronic condition & behavioral healthcare, and help patients save time away from work. 
  • The top performing health plans are using telehealth solutions to help patients quickly and proactively address their problems. When delivered appropriately internally or by a trusted external partner who specializes solely on virtual care, you can improve engagement and trust and significantly enhance the patient experience. 

3. Improve consumer engagement

  • According to a Deloitte study, health plans, clinicians, health systems, medical device companies, biopharmaceutical organizations, etc are all engaging patients and are having a lasting impact on the member’s experience. Deloitte identified a few key touchpoints during a patient’s health care journey when active interaction with the healthcare system peaks. One of the most important touchpoints was around accessing new channels of care. They concluded that more consumers are using quality ratings than in previous years and consumers are increasingly open to new channels of care. Work with your health plan sales and marketing teams to engage and inform the right segmented population of the tools at their fingertips. 

4. Deliver connected care via Telemedicine 

  • Health plans and provider groups use telemedicine to assess, diagnose and treat patients despite their geographical location. The use of advanced, secure telecommunications technology improves the member’s access to care, enhances health outcomes, and in turn, improves CAHPS results.  
  • Telemedicine enables reaching more patients in underserved and remote areas, it provides uncharacteristic timely access to specialists, and promotes partnerships across a wide range of clinical care settings.   
  • According to a study published in the Journal of Health Affairs, Gastroenterologists and Endocrinologists used telemedicine more than other specialty clinicians during the COVID-19 pandemic. About 77% of endocrinologists reported using telemedicine. 
  • In order to keep pace with competition, health plans must amend their policies, invest in new key partnerships, and cover devices on formulary. They should have established policies for reimbursement for telemedicine, their rates should be similar to in-person care, and their actions will emboldened their mission of being a patient-centric health plan.  



Consumers will continue to demand improved access to care and tools that empower them to better manage their health. In order to excel in an area that now encompasses a third of a payer’s star rating, health plans must establish an immediate and clear mission backed by leadership, collaboration from across the entire health plan, and strategic vendor partnerships when the scenarios are right for them. There is no time to wait. Spending 12 months building and planning for a longer-term strategy will leave health plans too far behind those aggressively setting the pace.





About the Author


Tom Shankle

Tom Shankle was brought aboard as the Vice President of Enterprise Payer Sales. He has led national Payer sales & client retention for 3 different organizations over the last 7+ years. From consulting, medical record retrieval & review, SaaS platforms, and industry-leading services, Tom has provided strategic solutions to over a hundred health plans to date. Prior to that he sold health insurance and represented the payer industry for several years.


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