The example in this post is of the Health Rosetta template being completed for one of the components -- Concierge Style Employee Customer Service. The goal is to get your feedback on whether this is actionable. Depending on the size of your organization, share it with your benefits director, CEO, CFO or benefits consultant to get them to evaluate whether there is enough information to take action. If the Health Rosetta concept is new, I'd invite you to read the introduction to the concept and rationale as well as the comparison between the status quo and the Health Rosetta. Health Rosetta certifications will be market-driven and are loosely analogous to LEED and Fair Trade (click links for how the analogies are applied to healthcare) to accelerate the movement to a higher-performing system. The following is a blurb from that piece:

Just as the next generation of technology companies required a new technology stack, the health ecosystem needs a new health plan stack. New incentives and payment structures for providers, along with better access to information with new consumer technologies, and an array of new technologies are enabling the shift. Various pay-for-value incentives are driving us to look for ways to optimize health and prevent illness. A key component of the emerging, more democratic, landscape is a commitment to openness, feedback and learning. To rapidly innovate, we need open source and open innovation to drive our a learning health system.

See also Transparent Medical NetworkValue-based Primary CareTransparent Pharmacy Benefits and ERISA plan checklist as examples of other sections of the Health Rosetta. The text below is an example of a completed template for the Concierge Style Employee Customer Service section. 

What Is Concierge-style employee customer service?

Concierge customer service addresses a substantial challenge that exists for health consumers today – namely that the benefit and healthcare ecosystems are complex and costly to understand and optimally navigate.  Current trends toward high deductible plan design only amplify the time and money that consumers invest as they attempt to make more intelligent decisions.  Proliferation of point solutions that address 1-2 discreet consumer needs, such as scheduling, price transparency or provider finders, still leave the individual to synthesize information across disparate sources.  Often, the member is attempting to access and understand information from these fragmented point solutions when she has an acute health need and is not at her best.  In the moment of need, many health consumers are aren’t able to access the information and support they need, and incur avoidable costs of care as a result.

Concierge service provides a simple solution to the fragmented experience that many consumers are forced to navigate independently today.  In this sense, concierge customer service becomes the conductor that harmonizes much of the discord that challenges healthcare consumers today. The concierge processes all the critical dimensions to be considered as the health consumer is contemplating or accessing care.  As a result, the health consumer has one point of interaction rather than many and is delighted with an experience that absorbs complexity and distills information down to understandable, actionable guidance.

How Does It Work?

Concierge services are available as a subscription benefit for employees, plan members and patients in value-based reimbursement contexts.

There are different forms of concierge offerings.  At one extreme, there are progressive concierge services driven entirely by algorithms that offer guidance based on machine learning.  At another extreme, there are more traditional concierge services that are high touch and person-to-person.  In the middle, there are hybrid models that are built on “human driven” technology, offering a balance between live support and technology driven solutions for health consumers; members can speak with live support or, if they prefer, navigate through an intuitive mobile interface.

Members can access concierge services for a broad spectrum of support.  A member can receive triage support, understand what care is appropriate given, learn where to access care based on her benefits, schedule the care, predict her approximate cost exposure, and receive advocacy support for claims and billing questions – all in one seamless concierge interaction.   The key to a true concierge experience is integration of information so that the consumer has access to simple and actionable guidance when they need it – without headache or hassle.

To enable this full spectrum of service and increase the value proposition to health consumers, concierge services are ingesting more and more data to improve the support offered.  Feeds include plan design information, provider network information, real-time tracking of benefit consumption like deductible and out-of-pocket progress, individual preferences, and cost and quality information.

Why Should You Support It?

There are three reasons to support Concierge services for health consumers:

  1. Concierge services engage members.  Well-designed and executed concierge services have simple, elegant user interfaces and member experiences.  Information from numerous sources is synthesized and presented to members in a manner that they understand – be it through pure technology solutions or live support.  When consumers can easily access and understand complex information in a time of need, it offers peace of mind, makes their life easier, and they use the service frequently.
  2. Engagement yields savings. Health consumers who are engaged and aware of the implications of their consumption decisions are empowered to more intelligently navigate the care system.  This means they can avoid unnecessary expense, avoiding wasted money and time.  As health consumers use concierge services frequently and stretch their healthcare dollars further, risk bearers like employers, insurers and providers accrue savings as well.
  3. Savings from concierge support can be realized in year.  Many programs that employers have invested significant dollars in, like wellness, require years to deliver return on investment, if they ever do.  Concierge services can deliver savings in a year as members are guided to avoid unnecessary, high cost care.
  4. Concierge support in a “critical moment” builds lasting affinity among health consumers – be they employees, members and patients.  Helping individuals understand their benefits and access the optimal care in a time of need can generate strong consumer awareness and appreciation for health benefits.  It can also serve as a powerful teachable moment that builds awareness of how individuals can be smarter healthcare consumers on an everyday basis.

The Diagnostic Toolbox

Key Elements

Below are some of the components that are integral to a comprehensive concierge offering:

  1. Deep understanding of the benefits context.  To help the health consumer make better decisions, a good concierge service considers the suite of benefits the member has access to, understands the individual’s plan design, and the individual’s current consumption of care (i.e. progress toward their deductible).
  2. Clinical support based upon triage protocols.  Identifying the health consumer’s needs often begins with triage of an individual’s symptoms.  A concierge service then guides the consumer to the appropriate level of care.
  3. Network directories.  When consumers receive guidance to the appropriate level of care, robust concierge offerings integrate the appropriate provider directories.  A concierge service should accommodate complex network designs, including centers of excellence, on-site care clinics or narrow networks.  The concierge directs members to the highest tier in-network providers for the highest level of care at the lowest cost, avoiding network leakage and the costs that consumers can incur as a result.
  4. Price transparency.  It’s helpful for consumers to understand what the cost of an encounter is likely to be so that they are prepared both clinically and financially for appointments.  Concierge services should integrate this information as part of the consumer as they guide members to care.
  5. Scheduling capability.  Exceptional concierge services go a step beyond and will schedule care on the consumer’s behalf.
  6. Understanding of the individual consumer.  A hallmark of true concierge care is a real understanding of each individual consumer, her preferences and her health profile so that care itineraries a concierge service provides for the consumer are personalized and will be adhered to.

Ensuring Quality

While there aren’t reference resources that assess the quality of concierge services, there are key performance indicators that indicate the quality of a concierge service.  Here are a few relevant quality dimensions to question:

  1. Engagement.  What portion of a concierge service’s addressable population is using the service and how frequently?
  2. User Satisfaction. What is the net promoter score associated with the concierge service.  Would members recommend it to a friend or loved one?
  3. Savings.  What savings has the concierge service delivered for members to date?
  4. Building initial awareness of concierge services with healthcare distributors.  The concept of a concierge service in healthcare is still new.  Most health consumers still receive benefits from their employer, who are typically reliant on benefits brokers or consultants for direction when selecting benefits.  In other instances, consumers are purchasing healthcare on public or private exchanges and could benefit from a concierge service being bundled with medical coverage.  Regardless of the distribution channel, upstream stakeholders need to be aware of and support concierge services so that the health consumer can access the service downstream.
  5. Breaking Subscription Cyclicality.  Employers and brokers / consultants consider benefits decisions annually in advance of open enrollment.  However, concierge services can be implemented off cycle and can be introduced successfully in advance of open enrollment as a benefit that can help consumers select the best plan for their circumstance.  Many times, consumers are comfortable selecting higher deductible plans when they know they will have concierge support as they navigate the care system and manage their care.
  6. Remaining top of mind for health consumers.   Concierge services need to maintain a high level of consumer awareness so that consumers reach out in a time of need.  Maintaining awareness requires commitment to frequent marketing campaigns, webinars, development of case studies and incentives that reinforce use of health concierge services when consumers need to access the care system.  These activities require continued support from distributors after a concierge service is implemented.

Challenges to Expect

  1. Employee Education: Such models will require continued messaging and clear, easy to understand action steps.
  2. Data Sharing: It could be difficult for your concierge service to obtain pricing and quality information from local providers. Since it is your spending, you have a right to this information and the service provider should be experienced overcoming this barrier.

Action Steps

EVALUATE the return on your investment realized from current health benefit tools by assessing member utilization rates and savings delivered.  

  • If employees, members or patients aren’t using the tools provided in their benefit toolkit, it may be that the health consumer finds them overly complex and fragmented.
  • Concierge services integrate and coordinate a vast array of fragmented solutions within the  health benefits suite, enhances engagement, and optimizes benefit utilization to lower costs.

SURVEY your member population’s aptitude to understand and efficiently navigate the benefits landscape.

  • Do your members have an easily accessible resource to guide them through the lifecycle of a healthcare episode?
  • Are you confident in the ability of your members to utilize the appropriate resources at the appropriate time to make educated decisions while at the point of healthcare consumption?
  • Through the holistic understanding of a member’s physical and fiscal profile, concierge services can guide the member to the most efficient, effective, and satisfying method of care every time they purchase healthcare.

ASK your broker, consultant, insurer or TPA if they are familiar with concierge offerings and how they may benefit your health plan.

Shared Resources

Please let me know if there are any background documents that would be helpful for this item.

Case Studies

Concierge Style Employee Customer Service providers

Compass Professional Health Services  

Zest Health 

Disclosure: The original draft of this section of the Health Rosetta was written by Shawn Ellis of Zest Health, one of the providers of these types of services.