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Payors have to balance the dual — often conflicting — goals of containing costs and maintaining plan member satisfaction. Cost containment measures, like benefit plan changes, can seem burdensome to members. Yet we know that when members understand why a change is needed and what they have to do to follow through, the transition can be smoother and more successful.
CVS Health approaches these member transitions systematically, identifying not only those members who may be directly affected by a plan design change but also those who may benefit from extra support. For example, when a plan makes a formulary change, we employ predictive modeling to identify members at higher risk for dropping off therapy or calling into Customer Care after the change. We then tailor our communication strategy to the members’ range of situations and risk profile.
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Ensuring that our communications resonate with members is also critical. Working with experts in consumer research, we have conducted in-depth telephone interviews with a number of pharmacy benefit management (PBM) client decision makers. These interviews helped us define and understand payors' perspectives and reconfirmed that member messaging should be straightforward and easy to understand. It should provide clear next steps on what the member needs to do and the information enabling them to act, such as medication options to discuss with their prescriber. We then tested messaging and communications that incorporated these insights with consumer focus groups to evaluate their response to style and language, in addition to the content of the messages. Any additional feedback was used to further refine the approach and messaging.
Members generally prefer their benefits not change and can be skeptical about the reason behind a change. Whenever possible, communications should clearly explain why a change is happening, and how the change will benefit both the plan and the members.
The Consumer’s Turn
Consumer focus groups echoed key payor insights. Participants preferred simple, direct language without jargon or unfamiliar terms. They wanted specifics on how a change would affect them and what they may need to do as a result of the change.
Other insights gained were more subtle. Responses to our communications showed that effective messaging needs to:
Prioritize member well-being over cost savings
|Acknowledge the physician’s importance in medication decisions|
|Give members a choice about actions to take|
Getting Down to Specifics
Word choice mattered to consumers. Focus group participants felt that the use of words like “try” and “alternatives” gave them a sense of control and that a change was not a mandate. They also responded more positively to “generic alternatives to the brand-name medication you are taking” than to “alternatives to your medication.” The difference? The first communicates that the generic medication is the same, not a different medication with potentially different properties. Focus group participants generally had positive feelings about generics and associated them with cost savings.
Focus group members were also sensitive to tone and perceived implications. Language such as “your employer and pharmacy benefit manager have found other medications that are as effective in treating your condition” could be seen as implying that the employer or PBM had medical expertise or were choosing medications for them. In addition to the words used, the order of the words mattered as well. Participants felt that references to “lower-cost medications that are safe and effective” implied that cost was more important than safety and efficacy.
Sample Member Engagement Toolkit
Words and Design
Design also impacted a message’s effectiveness. Headlines help cue readers to the significance of the message, and bolded or bulleted text help them get the gist of the message even at a quick glance. Solutions and options available to recipients, and a clear call-to-action or next steps message, need to be stated clearly. Communications should appear professional but warm, avoiding design or illustration that’s overly playful or cartoony. We want the members to get the gist of the message within four seconds - or at a quick glance.
We communicate with members through a variety of channels, including email and text, as well as telephonically, both with live calls and interactive voice response (IVR). We apply what we’ve learned from our research to these communications — including in IVR scripts. The insights we’ve gained about messaging also help inform the training for Customer Care representatives.
As health care costs continue to rise, and plans look for more ways to control spending growth, benefit plan changes are increasingly common, including moves to high-deductible health plans, more restrictive formularies and narrowed networks. Effectively communicating about these changes can help improve member engagement and satisfaction while also helping to achieve the plan goals.
Our success in helping people on the path to better health depends on how well we engage members and encourage them to take the right steps.
Helping members get a smooth start with their new PBM can improve satisfaction and results.
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