Solving health plan challenges: making healthcare experiences better for all

Perspective: Connected care | Capability: All | By: Carelon

For leading health plans, improving healthcare experiences for members and for providers is often a strategic priority each year. What’s needed now to make those improvements? Our Chief Growth Officer, John Hastings, provides his perspective and more.


As Chief Growth Officer of Carelon, John Hastings often talks with health plan leaders about the biggest challenges they’re facing today. One challenge he’s heard repeatedly is the need to improve the experience that members and providers have with health plans. In the interview below, John talks about how Carelon can help health plans achieve that goal.


Why are health plans focused on improving the member experience?


Improving the member experience is very important for health plans because, ultimately, if you simplify the system, if you improve their experience, you are building trust.

When you build trust with your members, engagement improves tremendously. People are more apt to follow their care plan, take their medications on time, address their gaps in care, see their provider on a regular regular basis, and so on. Health plans want to deliver a personalized, intuitive, and guided experience for their members because it improves the entire care journey.


How does Carelon support health plans working to achieve that goal?


Carelon helps improve the member experience in multiple ways. With our advocacy capability, we can identify and engage those individuals who need the most support. We then create a highly personalized experience for them by using data and understanding them across a whole-health spectrum, which includes physical, behavioral, and social drivers of health.

This is a complex industry. It’s fragmented. If you can have a complete view of your members, you can better understand their health and what might be driving it. By supporting high-quality care and a fully integrated whole-health view, you’re improving outcomes and you're improving affordability for the members and, ultimately, the health plans that serve them.


How does improving the member experience impact Medicare Advantage plans, in particular?


In the Medicare Advantage space, it’s critical. Quality metrics have a big influence on Star Ratings, and those Star Ratings are very important. They help health plans understand the quality of their members’ experience. But they also go into determining what health plans receive from the government in terms of premiums. Carelon is very focused on helping health plans improve those Star scores. For example, our own Advanced Primary Care solution is delivering outstanding Star results on their behalf.


Improving the experience also applies to providers within a health plan’s network, right?


Absolutely. Leading health plans invest in improving the experience for their providers as well. If a health plan can provide data and guidance to providers to make their days better, to make their workstreams more efficient, to help them improve the quality of care, then the relationship between providers and health plans improves, and the member experience does too. The provider experience is a big part of the full equation. We really are all in this together.


How does Carelon help health plans improve the provider experience?


Carelon stands out in that endeavor. We work closely with the provider community, partnering with them on value-based care contracts, technology, and clinical data to support their practices and make them as efficient as possible.

We also employ many clinicians who are at the heart of our provider-facing solutions. Our clinicians play instrumental roles in supporting providers with data and insights that drive evidence-based clinical decision-making, with multidisciplinary care teams that enhance care delivery, with platforms that the provider community often says they prefer over others, and much, much more.

Providers appreciate working with Carelon because we are committed to making their experience easier. And at the end of the day, creating better experiences for them and for members is one way we help health plans succeed in a competitive market.


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