On the Future Healthcare Today Podcast with Lucas Hunsicker, Kristin Gasteazoro, Senior Vice President of SmartShopper Sales and Client Performance at Zelis, and Reagan Greene, Vice President of Brand, Marketing, and Communications at Blue Cross of Idaho (BCI), dive into the significance of personalized messaging and care delivery strategies.

In their discussion, they outline different tactics aimed at revolutionizing healthcare experiences, emphasizing the value of personalization and innovative approaches to cater to diverse consumer needs. Their insights shed light on the continuous efforts to improve healthcare accessibility and effectiveness by using digital tools and tailored communication strategies.

In the Future Healthcare Today Podcast, hosted by Lucas Hunsicker, featuring Kristin Gasteazoro, Senior Vice President, SmartShopper Sales and Client Performance at Zelis, and Reagan Greene, Vice President for Brand, Marketing and Communications at Blue Cross of Idaho (BCI), they focus on revolutionizing healthcare experiences and consumer engagement.

During the podcast, Kristin emphasizes the importance of empowering members through strategic partnerships, addresses the resurgence in healthcare claims post-COVID, and highlights the industry’s response to escalating costs. This demonstrates a transformative move towards a more unified and meaningful member experience. Reagan explored the necessity of understanding consumer preferences in communication and media consumption, advocating for continuous support throughout the healthcare experience. Both guests stress the role of measuring outcomes and improving strategies to adapt to the evolving consumer behaviors and media landscapes.

Despite healthcare’s critical importance, the intricate nature of insurance plans and healthcare information can often leave individuals feeling adrift. A recent Bend Financial report found that 56 percent of respondents felt “completely lost” when trying to understand health insurance, with even higher rates among people on a family member’s job-based insurance (75 percent) or those on COBRA (68 percent). The solution? Engagement. In this episode of the Future Healthcare Today podcast, host Lucas Hunsicker engages in a discussion with Rousseau Kluever, Director of Product, Healthcare Guidance, at Zelis, to explore innovative strategies for bolstering meaningful member engagement.

From personalized solutions, which incentivize proactive health actions, to the importance of an omni-channel strategy that meets members where they are, Kluever emphasized the necessity of a member-centric approach. By prioritizing personalization and accessibility, he explained how healthcare organizations can empower individuals to focus on their health goals without the burden of navigating the complexities alone. As the conversation unfolds, it is evident that the future of healthcare lies in these personalized experiences, seamless interactions, and genuine support for members. By embracing innovative approaches and leveraging technology to its fullest potential, healthcare organizations can foster deeper connections with their members and ultimately enhance the quality of care delivered.

Despite healthcare’s critical importance, the intricate nature of insurance plans and healthcare information can often leave individuals feeling adrift. A recent Bend Financial report found that 56 percent of respondents felt “completely lost” when trying to understand health insurance, with even higher rates among people on a family member’s job-based insurance (75 percent) or those on COBRA (68 percent). The solution? Engagement. In this episode of the Future Healthcare Today podcast, host Lucas Hunsicker engages in a discussion with Rousseau Kluever, Director of Product, Healthcare Guidance, at Zelis, to explore innovative strategies for bolstering meaningful member engagement.

From personalized solutions, which incentivize proactive health actions, to the importance of an omni-channel strategy that meets members where they are, Kluever emphasized the necessity of a member-centric approach. By prioritizing personalization and accessibility, he explained how healthcare organizations can empower individuals to focus on their health goals without the burden of navigating the complexities alone. As the conversation unfolds, it is evident that the future of healthcare lies in these personalized experiences, seamless interactions, and genuine support for members. By embracing innovative approaches and leveraging technology to its fullest potential, healthcare organizations can foster deeper connections with their members and ultimately enhance the quality of care delivered.

People often turn to family, friends, and Google to make healthcare decisions and find healthcare providers. This can lead to confusion and misinformed decisions. Healthcare partners can – and should - step in and offer solutions that simplify this process and provide knowledgeable information. For example, care guidance tools can make the care selection process simpler for members. Healthcare partners provide services that enable people to receive high-quality care.

These omni-channel solutions assist members by meeting them where they are, whether through preventative care or other programs, and by helping members make timely and appropriate healthcare decisions based on their age, gender, and other demographics. Additionally, care guidance solutions can close care gaps by motivating members to see a doctor and reducing barriers to care. With the mission to ensure a healthier population while increasing member engagement and satisfaction, healthcare partners can improve the care experience for members.

These were the key themes of the latest Future Healthcare Today podcast, where Kristin Gasteazoro, SVP, SmartShopper Sales and Client Performance at Zelis, discussed care guidance tools and omni-channel solutions for improving member engagement.

The Affordable Care Act, far from simplifying healthcare, has introduced many more complexities, making the jobs of HR workers even more challenging as they attempt to keep pace with the fast-changing regulatory environment. This has created the opportunity for healthcare brokers to step in to fill knowledge gaps and extend the value of the HR team. In the highly competitive market, brokers need to be equipped with innovative technology and data capabilities to be successful.

Their expertise in understanding evolving regulations enables brokers to help navigate the complexities of benefits and forge stronger relationships with clients. Brokers uncover network gaps and facilitate comparisons with competitor network performance leading to actionable insights. Moreover, these experts improve time management, facilitate better decision-making for insurers, and deliver cost savings with programs such as SmartShopper.

These were the key themes of our recent Future Healthcare Today podcast about the broker space and how brokers can partner with employer groups to build strong client relationships. Host Lucas Hunsicker talked with Rob Graybill, Senior Vice President, Strategy & Business Development at Zelis, and explored the healthcare environment and how innovative solutions with advanced analytics are helping client connections.

The Transparency in Coverage (TiC) regulations provide further clarification for the use of Machine-Readable Files (MRFs) for the health insurance industry. These rules require that healthcare plans and issuers offering health insurance coverage in individual and group markets disclose in-network provider-negotiated rates through MRFs. The outcome will be increased data transparency for payers, providers, and members and improved accessibility and usability for member-facing transparency tools.

One of the challenges with MRF files is that they are typically very large and require significant computing power to download, which makes it difficult for members to access them. To overcome this challenge third-party tools have been developed that provide an infrastructure to host the data so that it can be readily available. Both payers and providers can use the payer rate data to evaluate their competitive pricing position and improve provider contracting efforts.

These were the key themes of our recent Future Healthcare Today podcast about how TiC regulations have affected the use of MRFs. Host, Lucas Hunsicker, talked with Dennis Charland, Senior Vice President, Transparency and DaaS Sales at Zelis, about the recent release of MRF rate-based files and how they will change the market.

The healthcare industry has seen its fair share of disruptions in the last few years. With the advent of telehealth and a renewed interest in taking charge of their healthcare, many members have interacted with their plans like never before. However, new interactions can lead to increased expectations for the future of healthcare

Zelis conducted a study to discover how satisfied members are with their healthcare journey. The results included pits and peaks, each revealing another new and important consideration for payers. However, common needs emerged. Members expressed the need for more clarity, control, and guidance on their healthcare journey.

These three concepts emerged for good reason as each provides a member with the ability to take a more active role in their healthcare journey. Further, it allows members to make more informed decisions about their health.

But what does this mean for payers looking to bolster their relationship with their members? How can they bring clarity, control, and guidance to the forefront of their solutions? What do those three aspects look like in terms of on-the-ground experiences?

To unpack and better explain these questions, Future Healthcare Today spoke with Madison Goldfischer, Vice President and Head of Product for Member Empowerment at Zelis, to find out more. This latest podcast dives into the specifics of the recent Member Empowerment Survey, what members expect when dealing with their partners, and how healthcare can learn from other industries with a customer-focused mindset.

Previously, on the Future Healthcare Today Podcast, we heard from Mary Piecuch, Senior Vice President of Product Strategy, and Erick Russell, Director of Network Operations, both at Zelis, about the basics of a reference-based pricing model and what payers, providers, and members need to know to make the most of the solutions and how it can to beneift the patient experience.

However, when the conversation turned to the benefits that come from embracing RBP, the conversation lasted far longer than we expected. As such, we decided to reconvene later with our subject-matter experts to dive deeper into the myriad benefits that come from properly using a reference-based pricing model.

Ranging from cost-conscious decision-making ability to the freedom to treat patients without fear of a long or arduous payment process, there are many ways that payers, providers, and members all benefit under an RBP model. Benefits can be realized as soon as the model is embraced, but both Mary and Erick expressed that there was something else that was more exciting to them.

Beyond just the benefits in the immediate term, Mary and Erick shared some of their thoughts on the future of RBP models, and how Zelis’ recent acquisition of Payer Compass will impact the future of reference-based pricing.

There is good reason to expect continued investment and innovation around the model, but what does that mean for those interested?

It should come as no surprise that recent events around the world have created an atmosphere of change almost everywhere. People are living radically different lives than they were three years ago, and with those changes comes a desire for the services they use to keep up with their lifestyles. In this environment, it seems almost inevitable that something like the reference-based pricing model for healthcare would emerge as a much-needed solution to modern issues.

A reference-based price model, in short, gives patients and payers a way to ensure adequate healthcare is administered, paid for, and covered while avoiding staggering provider contract fees or out-of-network prices. RBP can be used in several ways, including as a full network replacement, as support for out-of-network savings, narrow networks, or even custom network build options.

This is largely thanks to the aforementioned open access to providers and zero network limitations, which allows members to make informed provider decisions that align with their personal preferences. Additionally, RBP helps providers make sure that if someone comes in needing assistance, they can administer care without the worry of a long and arduous arbitration process if the patient is not an in-network member.

To better explain the concept, and to offer additional context as to the benefits of RBP, Mary Piecuch, Senior Vice President of Product Strategy and Erick Russell, Director of Network Operations, both at Zelis, joined the latest installment of the Future Healthcare Today podcast.