How to Shift from Managing Complexity to Creating Value

// By Jane Weber Brubaker //

If your health system participates in value-based contracting, you have a vested interest in making sure you’re optimizing the three R’s: right care, right time, right setting. Easier said than done.

So what is the secret to orchestrating all the variables that go into a patient’s decision to get care, choose a provider, and make an appointment? And from the provider and payer perspective, how do you push the right levers to drive maximum revenue while improving care quality and patient outcomes?

Craig Thomas, CEO, Lucerna Health

When payers and providers are on the same team, working together to achieve common goals, the answers are easier to come by. Technology is unsnarling the complexity that has plagued the industry and prevented it from moving forward toward a more sustainable future.

“I used to have a saying that companies spend more time managing complexity than they do creating value,” says Craig Thomas, CEO of Lucerna Health. “But when you create pockets of deep integration, you do, in fact, simplify complexity. When you can simplify it, then you can focus on supporting providers and patients.”

During a recent webinar, “Segmenting Healthcare Populations to Drive Key KPIs,” Lucerna Health’s engagement director Lynn Locke shared three examples of dynamic marketing automation campaigns that drive value by leveraging data integration, technology, and analytics.

Lynn Locke, engagement director, Lucerna Health

Lucerna Health partners with Redpoint Global, using the “Intelligent Orchestration” layer of Redpoint’s rgOne Platform.

Locke says, “Redpoint tools enable us to take all the complex segments that are involved with healthcare and turn that into something scalable.”

The orchestration layer of Redpoint’s rgOne platform allows marketers to build personalized journeys tailored to individuals. Chris Evanguelidi is director of enterprise healthcare at Redpoint Global. “The first thing is getting the data fit for purpose to be able to give you enough insights,” he says. “We’re an open garden platform. We’re going to connect to all the different sources of data that you have and bring it into the CDP [customer data platform].”

Chris Evanguelidi, director of enterprise healthcare, Redpoint Global

Redpoint has built bidirectional APIs and deep integration connectors to email service providers, content management systems, and cloud platforms. Once the connector is built, it becomes part of Redpoint’s code base and is available for all clients.

“From there,” he says, “we’re taking every batch, episodic, static engagement journey and bringing them to life through our orchestration engine.”

In the context of value-based care models, patient engagement is key to driving performance. The sheer number of variables involved in driving engagement makes sophisticated technology a necessity:

• What is the patient’s health plan?
• Which providers are in the plan?
• Which providers have availability?
• What state does the patient live in?
• What is the patient’s age?
• Does the patient have chronic conditions?
• Is he or she a new or existing patient?
• What was the patient’s last encounter?
• What was the setting — telehealth, urgent care, doctor’s office?
• What screenings does the patient need?
• Does the patient have a primary care physician?
• What is the patient’s preferred channel?

“From a marketing campaign and engagement perspective, the clients we work with tend to have practices across multiple states and integrate with multiple payers,” says Locke. “So when you start to bring all that data together, we really do have to rely on the technology and the orchestration to enable us to build out reusable assets that we can send out at different stages for different segments of the population to get the appropriate message to the appropriate audience.”

In this video, Craig Thomas, co-founder and CEO of Lucerna Health, shares his perspectives on why the healthcare industry needs to simplify complexity, and how to do it.

Thomas explains that, rather than sending out a generic quarterly newsletter to patients with diabetes, “what we do with Redpoint is we’ll break that diabetic population into all kinds of sub-segments, and then navigate them to the right service and the right provider at the right time, given all the clinical, claims, and consumer data we have.”

“There’s a catalog of probably 30 to 50 journeys that Lucerna can bring to the table right out of the gate,” Evanguelidi says. Locke demoed three campaigns in the webinar:

• Welcome
• Patient Satisfaction
• Care Gaps

Welcome Campaign

Patients come on board a health plan due to a change of some kind — they age into Medicare and enroll in a provider-sponsored Medicare Advantage plan; start a new job and change to the company plan; or enroll in a health insurance exchange plan. The reasons are many, varied, and ongoing.

How do you begin engaging with them and building a relationship? Whether you’re the plan sponsor or you partner with a payer in a joint venture, how do you steer patients toward services that are beneficial to their health while helping you achieve your financial goals?

The goal of the welcome campaign is to get people to schedule an initial visit. In the demo example, Locke explains that the welcome stream consists of seven emails that go out over a period of several weeks. As new members come on board, they enter the stream and receive personalized communications tailored to them. “Once they have scheduled the visit, then we know that has happened and we’re able to then suppress people out,” Locke says.

Emails are dynamically generated based on pre-set variables. The behavior and response of email recipients determine the “next best action.” The marketing automation running these programs is based on machine learning models. Once the campaigns and intelligence behind them are built, the campaign activities are triggered based as new data comes in and based on established rules. 

Patient Satisfaction Campaign

Patient satisfaction is an important indicator of quality, and that is the principle behind payers offering financial incentives to providers based on patient satisfaction scores. From the consumer perspective, if patients are unhappy with their experience, they are likely to move to another provider, and may post negative reviews online.

Lucerna Health’s patient satisfaction journey seeks to gauge patient sentiment following a clinical encounter, identify issues, and use the feedback to continuously improve patient satisfaction. “All of the operational pieces are intended to solicit feedback, integrate that feedback, and then provide that back to the operational teams for actual outreach and making sure that for patients who perhaps didn’t receive the service they were expecting, that those [issues] get resolved,” Locke says.

Lucerna Health uses Net Promoter Score, or NPS, to measure satisfaction. Scores are based on the likelihood of the respondent to recommend the service or provider based on their experience. “Promoters” rate their experience as 9 or 10 on a scale from 0 to 10; the range for “Passives” is 7 or 8; “Detractors” give a score of anything below 8.

Similar to the welcome campaign, this journey is set up to send dynamically generated, personalized versions of the survey based on multiple variables. Members receive surveys within two days of a clinical encounter. “We are proud to announce that we have over a 20 percent response rate on patient surveys,” says Locke.

“We are sending out UTM tracking parameters that allow us to know what facility, what doctor, what date their appointment was — all those important things that help us to then provide feedback,” Locke says. “We can tell the specific region, that the appointment happened, the different market segments, if it was a Medicaid patient versus a Medicare versus a commercial patient, whether they went to telehealth or urgent care or primary care. All of those things trigger different surveys.”

Care Gap Campaign

Prevention is a basic tenet of value-based care. The cost of prevention is a fraction of the cost of treatment. Engaging patients in prevention may involve, for example, identifying who needs a cancer screening, when they need it, and where your health system can provide it. In the demo, Locke shows how an audience was selected for a care gap campaign:

• 79,000 patients had the care gap.
• 7,000 of these patients see doctors who currently have availability.
• 1,200 already have a visit scheduled.
• 500 are high-risk and will receive a different communication.

Some of the remaining balance are new patients, and others have established relationships; some have opted in to receive SMS while others haven’t. “When we ran the audience, we ended up with just a few thousand people getting the communication, but this is a campaign that can be set up to run every day, every week, and it can help control for some of those capacity issues,” Locke says. “Sending out communications to 79,000 people all at one time is probably not a good thing for capacity.”

The strategy is achieving the desired result of managing access. “In the last year’s net results, the client was able to actually meet and exceed all of their access metrics to ensure that they were in good standing with the payers that they work with,” says Locke.

Overall, the patient engagement campaigns have been successful. Locke shares, “Over 40 percent of the completed visits for one of our provider clients were actually attributed back to campaigns.”

The shift from fee-for-service to fee-for-value has been a tough nut to crack. “The industry is so complicated, so fragmented, and so deeply rooted in the decades-old fee-for-service business model,” Thomas says. “Having the data and the capabilities — and really the will — to get through that transformation is an industry challenge. What we’re trying to do is get in the middle of that, between the payer and the provider, with capabilities and services to help them on that transition.”

Jane Weber Brubaker is executive editor of Plain-English Health Care, a division of Plain-English Media. She directs editorial content for eHealthcare Strategy & Trends and Strategic Health Care Marketing, and is past chair of the eHealthcare Leadership Awards. Email her at jane@plainenglishmedia.com.