If you are a health plan leader, you should seriously consider separating the care management from the member experience function in your organization. In this post we will explain the distinct benefits of such a bifurcation, which allows each team to focus on their specialized offering while collectively enhancing the overall service quality and member satisfaction.

Reduce burnout

The member experience team can focus on simple repetitive activities such as care coordination, scheduling, medication adherence, providing information and member education, reminders, and basically anything that isn’t clinical.

Meanwhile, the core care management team can focus on critical care management needs, developing and implementing clinical programs, managing chronic conditions, and ensuring members receive appropriate, high-quality care.

Care managers that practice at top of license are happy care managers.

Improve member satisfaction and loyalty

By having a dedicated member experience team, health plans can proactively address and refine aspects of the service that directly impact member satisfaction, such as customer service, navigation, member education, and engagement initiatives.

Satisfied members are more compliant and more likely to remain with the plan and recommend it to others, reducing churn and enhancing the plan’s reputation.

Improve outcomes

The care management team can use its clinical knowledge to design and implement programs that directly impact members’ health, such as population health management programs, preventive care initiatives, quality campaigns and personalized health plans.

The member experience team can follow through with members to support such programs and make sure members are adherent.

This division of labor can lead to better health outcomes, reducing utilization and costs for both the members and the health plan.

Streamline processes and efficiency

With clear delineation of responsibilities, both teams can optimize their workflows and processes without overlapping duties. This can lead to more efficient operations, with each team being able to innovate and improve their systems without the constraints of having to manage a broad range of diverse tasks.

Increase member engagement

A well-functioning member experience team can increase member engagement through effective communication and education strategies, leading members to participate more actively in preventive care and health improvement activities offered by the care management team. This synergistic effect can lead to healthier members and reduced healthcare costs over time.

Learn more

If you are experiencing challenges in member engagement and outcomes, we’d love to help. Twig Health is a turnkey service. We offer a virtual “front-desk” to your care management and quality teams. Twig’s remote nurses, co-piloted by AI, forge supportive relationships with members that lead to outstanding results.