How mPulse is aiming to use data and AI to engage patients

Bob Farrell says health plans and providers have plenty of data on their patients, but they’re not always getting the most of it.

Farrell is the CEO of mPulse, a company working with health systems and health plans to get more insights on their patients. The company has been growing significantly in recent years, completing the acquisition of Clarity Software Solutions over the summer. Clarity is the fifth company mPulse has acquired since December 2021.

With the addition of Clarity, Farrell says the goal is to use AI technology to “provide a plan or a provider with a 360-degree view of their members or their patients.”

With that information, he says, “They can do the things that allow that member or patient to really take charge of their health care, and ultimately to improve outcomes, while simultaneously driving efficiencies for the plan or the provider themselves.”

The company works with 450 healthcare organizations and 50 of the nation’s 60 largest health plans.

Steve Mongelli, president of mPulse and former CEO of Clarity, says joining forces can help improve the member’s journey and help payers reach their members in more relevant ways.

“Payers want to be in constant contact with their members, and you need to get them into a reliable digital relationship where they have access to information in their data,” he says.

Now, adding Clarity’s strengths, Farrell says he’s looking forward to serving customers with a complete health experience and insights offering.

“We have been very focused on getting the data necessary so that a plan can interact with their members at the right time, for the right reason, to take a certain next action that they otherwise might not,” Farrell says.

Using artificial intelligence and machine learning, mPulse works with providers and systems to review patient experiences and help identify potential risks for certain conditions, he says. Plans and providers can then begin earlier interventions to avoid more complex problems.

At that point, hopefully, patients can be moved to patient portals to engage with their systems and plans.

Health plans have data in different departments and work with different partners, so some patient information ends up in individual silos, Mongelli says. That makes it difficult to send consistent messages across a patient’s journey, he says.

Now with Clarity as part of mPulse, Mongelli says he sees “a very, very different opportunity for these payers to really connect with their members now in a coordinated way that will be impactful.”

Health plans are having mixed results in connecting with their members, with significant variation in performance, according to a J.D. Power report released in May. Member dissatisfaction can be costly. One in five employers (20%) said low employee satisfaction is a leading reason in switching health insurers.

Farrell says trust has eroded between health plans and their members, and plans are recognizing that reality.

“Plans, I think, are very focused on improving that trust, breaking down the barriers and frankly, dealing with their members in a way that those members have become accustomed to being dealt with through other industries like financial services, insurance, e-commerce, supply chain,” he says.

With employers and consumers facing higher bills and growing increasingly frustrated with rising costs, health plans are going to have to provide better service, Farrell says. Patients and businesses have greater expectations.

“That trust factor drives down further when I’ve got to pay 20% more and I get 30% less service, and I'm looking at an antiquated portal, or it just says, dial 1-800-Health-Plan, and, you know, I'm stuck in the water,” he says.

Health plans and providers both need to find ways to engage their members in their preferred method of communication. While email or text messages may work for some members, older patients may prefer calls over landlines or printed material in the mail.

But it’s also important for plans and health systems to engage in relevant ways, Mongelli says.

“As a consumer, you might receive a message that has nothing to do with you or the condition you have, and you feel a little alienated from your plan, because they're telling you to treat your diabetes, when you actually don't have diabetes,” he says.

But if plans can communicate effectively with patients, they have a chance to help them stay healthy, and plans will see benefits, Mongelli says,

“It's going to change how they think about their plan from a loyalty perspective and retention long-term,” he says.

Part of that effort includes building awareness of programs patients and members may not know about.

Farrell says some health plans have strong programs in areas like smoking cessation that aren’t well-known. The J.D. Power support says some programs to manage chronic conditions get good feedback from users, but they are underutilized.

“Having the programs is one thing, and getting people to use them is another thing,” Farrell says.

Patients are also dealing with health plans when they’re sick or a loved one is ill, and they are stressed and frustrated. Mongelli says health plans need to build equity with patients so when there is a time of crisis, the members may have some trust and aren’t gearing up for a fight.

If plans can build a proactive and positive relationship with members, the dynamic changes.

“If I'm getting clear information to help take care of myself at a care point, that's a different experience. And those retention metrics are going to be extremely different,” Mongelli says.