November 10, 2016

Top 6 Challenges for Blue Cross Blue Shield Association Member Companies

2016 has brought many challenges to the health industry. Difficulties with reimbursements and increases in medical costs has driven up the bottom line. Additionally, significant increases in funding of digital health startups over the past three years have brought an onslaught of companies disrupting segments of the payer business model. Fortunately, the Blue Cross Blue Shield brand is a household name that can carry member companies into Health 2.0.

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Over the past 15 years we have been working in digital health, including with BCBSA member companies. Based on our observations here are the six areas BCBSA member companies will be focusing on in 2017:

  1. DATA – BSBCA companies are in a unique position, collecting membership and claims information on over 100 million lives across covered areas. Rationalizing this data must be a top priority for organizations. Take member data for example, throughout various systems, Robert Smith may be known as “Rob Smith”, “R Smith”, “RJ Smith” or “Robert John Smith.”  The rationalization of this data is valuable as it enables an organization to gain a clearer overview into their membership. Having a broader picture of a member can help place the focus on preventative care rather than sick care. It can also provide insight into how members want to interact with your organization. Last fall, all 36 BCBSA insurers agreed to participate in Axis, leading the way to a national knowledge base on provider and procedure data. Is your organization ready to participate?

  1. PRODUCTS – In this era of applications with intuitive, personalized, and user driven design (a topic we will cover further down), it pays to take a customer-centric approach to every product. Particularly with the tectonic shifts happening in the payer space due to recent acquisitions and new payer models being rolled out (e.g. Vermont becoming the first state to pursue an all-payer model statewide). It is critical to make sure that products are interesting and relevant to how people are trying to make use of their healthcare information. The trend toward more transparency is pushing health insurers to provide more information to consumers, but the data has not yet unlocked the value that the industry has been expecting. As claims data on its own does not offer the kind of insight that consumers will find particularly helpful, it will fall to BCBSA members to offer insights of their own. In July of this year, Chicago based BCBS announced a suite of newly branded, international private medical insurance products that will serve multinational employers and individuals traveling globally – a great example of listening to your customers, and we are looking forward to the first review of these products. However, sometimes the smaller initiatives are what actually moves the needle. Recently we worked with a Blue to build a better provider search tool that attracted more users and increased retention by displaying the strength of their network.
  1. ROI ON TECH IMPROVEMENTS: Everyone in healthcare has bought into the importance of lowering costs and the nation’s insurers are no exception. Everything is changing with the ACA, and at least half of the new projects launched are not innovative initiatives but rather cost saving measures, efficiency improvements, and systems integrations to rationalize disparate systems. I will not dwell on the cost of healthcare from a general standpoint – it is enough to take a look at the cost of software implementation and the discrepancy between the initially quoted cost and the end cost after time overruns and quality assurance (QA) testing when the initial solution doesn’t meet the actual need (unfortunately pretty common scenario amongst in-house teams and IT vendors). At Vicert we track the following quality metric: number of defects in code delivered to QA per $100,000. Our number in 2015 was 3.4 defects per $100,000. As a result, our clients spend much less time re-testing and less development time fixing issues instead of creating new features and accelerating the product.
  1. WORKFLOW – In all large enterprises, speed to market can be a real challenge.   Inefficient development methods combined with the burden of bureaucracy and a shortage of technical resource can make managing workflow processes difficult. Of course, poorly managed workflow results in higher costs, and increased errors that can create a variety of problems down the line. One of the key challenges of large insurance companies is making their processes more nimble so that they can be more adaptable and responsive to changing consumer demands. This can be very difficult for a large organization to accomplish on their own. Hiring a vendor to help automate your most inefficient workflows can be an effective approach – almost like having a swat team focused on finding a problem and quickly resolving it.

  1. MULTICHANNEL62% of smartphone owners have used their phone in the past year to look up information about a health condition – 57% have used their phone to do online banking. The crossover is happening – but it will not result in total abandonment of desktops and other devices.  On the contrary, people tend to switch devices, but when they switch, what do they actually switch to? 60% of consumers who start an activity on a mobile phone actually continue on a laptop:

  • 90% of consumers who started purchasing a product on a mobile phone switched to a laptop
  • 85% who started checking their email on a mobile switched to a laptop
  • 69% who started researching on a mobile phone switched to laptop.

From a technical perspective after analyzing the behavior of consumers today, it is important for insurers to adapt to offering multichannel options to serve members through a variety of communication channels such as web, mobile and IVR. This also includes the ability to serve different consumer profiles that interact differently with a company based on their needs.  For example, 60% of millennials support the use of telehealth options to eliminate in-person health visits and 71% would like to have their provider use an app to book appointments, share health data and manage preventive care.

Consumers simply want to interact with their service providers differently than they have in the past. Association members must enable their client facing tools to be multichannel to respond to changing customer interaction preferences. What is necessary to achieve that? Read on!

  1. USER EXPERIENCE –  As Slack informed Microsoft a couple of days ago – it is not enough to simply copy the features 😉 Having multichannel customer communications alone is proving to be insufficient for most of the payers. Insurers are being challenged to redesign their interfaces with external constituents, clients, providers and employers in mind. Check out a guest blog by our partner IA Collaborative on how to implement user driven design in digital healthcare.
It is an exciting road ahead into 2017. Finding the right IT partner that will help your in-house team deliver innovative solutions while respecting your current operational imperatives is key. That means finding a partner that not only understands, but one that eats, drinks and sleeps digital health and health IT, and that understand the pressures of the modern enterprise and how to work within that environment to meet your needs.
Are you ready to take on the challenge? Join the conversation or reach out directly to me at:
Author: Digital Health Team
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