Why Consumer Success Depends On Business Processes 1/2

Navigating consumers: The hidden technology metric

Healthcare is changing, but health insurers need to change faster in some underappreciated areas to prepare for the most monumental shifts. Here’s what we know and what we don’t about the consumer imperative.

Though removed from health plan customers in some ways, as they experience it, modern, sustainable business processes and IT are necessary for convenient, quality healthcare—and for insurers to keep their business.Today, in the new healthcare economy, business processes are becoming a metric for the patient and health plan member experience.

Insurers have a long way to go when it comes to the actual experience of using a health plan. Far from being frictionless, using a health plan can be time-consuming and confusing—not something someone wants to do and something, eventually, they won’t have to.  

If customers on Medicare Advantage, Medicaid or Marketplace health plans cannot use their insurer’s website to find a hospital or doctor, or ask and get answers to a question about coverage, they might remember that next time they’re deciding whether to re-enroll or choose another plan. More of the health insurance market is becoming one where individuals are making the selection of insurer. The Medicare Advantage market is the business opportunity of the next decade—and one that could slip away if the customer experience remains bad.

Offering consumers immediate price and quality quotes on diagnostics and treatments is going to be a work in progress (and market-movers offering low-cost, retail diagnostic tests and basic primary care may be making the health plan’s job easier if not moot in that realm anyway). But targeting investments in improving business processes on back-end administrative functions as well as consumer-facing services—member communication, network navigation and customer service—could help in member retention, particularly in the rising individual markets.

When it comes to portals, and there are a lot of them on a spectrum, health plans can implement layer integration that links portal data with fax, paper and metric reporting services and bring it into a digital workflow. This bridges the digital and manual worlds still prevalent today and it ensures all of a member’s data is in place going forward, for the insurer, providers and members themselves.

That approach can also be used to expand member-facing information services, such as wellness content. A nimble layering implementation between wellness content and a health plan’s portal can make this doable without major challenges. Whether this seems to be a significant change, making communications with members even a little more pleasant and streamlined can have an impact on their perception.

In the second part of this series, we’ll explore the business process challenges at the other end of the patient relationship—providers—and three main ideas about its business evolution.

Author: Digital Health Team
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