Value-Based Care, Payers, and Patient Experience Data | Binary Fountain

July 02, 2020

Value-Based Care, Payers, and Patient Experience Data

By: Erik Fessler

value-based-care-payerAs value-based care flourishes, payers are starting to pay special attention to key steps on the patient’s care journey. In order to understand that journey and efficiently lower the costs of care, payers need to address questions about the member experience:

How do members navigate the systems payers have in place? How do they feel about the network of providers? Can members easily access important tools like telemedicine? How do members rate the overall quality of their health plan?

An increasing number of Natural Language Processing (NLP) powered tools are allowing organizations to swiftly collect and analyze bulk patient feedback. This technology allows users to quickly quantify and analyze open-text patient feedback. For payers, it’s a tool to understand and measure the entire patient journey and all aspects of member experience.

This post will explore how payers can use patient feedback data to improve patient experience, provider experience, and administrative workflows. Then, you’ll see how these improvements lead to lower healthcare costs and better outcomes.

How Can Payers Improve Patient Experience?

Payers can expand their access to customer feedback by increasing the types of surveys they analyze beyond CAHPS and HOS. Surveying can detect member sentiments on health plans, feedback on providers, and other trends in open-text feedback.

Organizations can build a comprehensive data hub by collecting patient feedback from surveys, call centers, social media reviews, and other member sources. Then, NLP analysis can turn that data into patient experience insights across multiple categories at the provider level.

Here are some ways payers are improving the patient experience with feedback data:

  • Capturing ratings and reviews in member portals so patients can see feedback and make decisions on their care journey
  • Providing scores for individual providers so members can utilize quantitative data from other patient’s experiences to compare options Proactively surveying members quickly after each episode of care to get real-time feedback
  • Using feedback to benchmark provider performance and help them improve. Physician and provider liaisons can follow up with providers on cost, quality, and patient feedback data
  • Leveraging scoring and feedback data in care coordination and referral management

NLP data helps payers understand what drives positive patient experience both inside and outside of the provider’s office. This includes members’ choices of their network providers on their patient portals and continues through each step of the care journey.

Quantify Patient Experience for Each Provider

Payers can also analyze patient feedback to measure provider performance. According to research, patients care most about the following provider experience quality measures:

  1. Thoroughness of examination
  2. Patient inclusion in decisions
  3. Ability to answer questions
  4. Provider’s attitude
  5. Patient perceived outcomes
  6. Amount of time spent with patients
  7. Provider’s follow-up with patients
  8. Clarity of care plan instructions
  9. Patient loyalty
  10. General Feedback

Payers can use these 10 patient experience categories to analyze feedback about each provider in their network. Subsequently, they can share insights and trends with their networks of providers to help guide better patient experiences.

Open-text, or unstructured, feedback allows patients to communicate their exact feelings and observations. In contrast, multiple-choice answers force survey respondents to compromise on the closest fit response. NLP technology allows payers to rapidly process this free-response feedback. First, the software detects patient sentiment through words and phrases in patient feedback. It can then easily quantify and translate those insights into patient experience scores.

Reducing the time period between care delivery and patient experience feedback is critical. In order to assist, software tools can integrate with APIs and health system EMRs for immediate, high-quality feedback. In addition, payers can publish this member-generated content on their websites and provide profiles to be transparent and consumer-friendly.

Here are ways insurers and managed care organizations can increase transparency by sharing patient experience data:

  • Create a Patient Experience score alongside Cost and Quality metrics for search pages and provider profiles
  • Allow patients to sort and filter patient experience scores by specific key performance indicators
  • Showcase provider feedback on member portals to encourage patient content

Supporting Providers, Solving Workflow Funnels, and Making Value-Based Care Possible for Payers

As payers capture patient feedback data to optimize their networks, they can also improve provider experience. Insights about network providers and staff will help payers understand how to support providers in their network.

  • Provider Performance Management: Use custom patient experience reports to understand trends and benchmarks for providers.
  • Referral Insights: Share patient experience insights with PCPs to broaden the data scope on referrals for members.
  • Internal Stakeholders: Optimize health plans and networks through Root Cause Analysis.

Provider feedback could be particularly useful as healthcare reimbursement shifts from fee-for-service based models to value-based payment programs. In order to keep the focus on patient care and maintain high-performance results, alternative payment models need to reduce provider burdens.

Provider feedback data will be an important source for effective change for payers through this value-based care reimbursement transition. Therefore, payers should track how their policies are affecting providers’ ability to care for their patients.

Insurance companies could also track how changes affect provider satisfaction. Happy providers lead to happy patient members, which make loyal customers. Not to mention, provider survey data is key to achieving the Quadruple Aim of healthcare, which you can read about here.

For more on payers and patient experience, browse these related posts:

About the Author

Erik Fessler
Marketing Coordinator

Request a Demo