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Perspectives

Healthcare Consumerism: Assessing Consumerism Capabilities

2014-11-25


As we've discussed in this series, health consumers seek payers that deliver a level of value, service and experience which matches what they receive from the best online retailers. Further, retail health consumers are increasingly empowered to spend their health premium dollars on payers of their choice. Payers responding effectively to consumerism's forces will have an advantage in attracting today's health consumer.

As we've discussed in this series, health consumers seek payers that deliver a level of value, service and experience which matches what they receive from the best online retailers. Further, retail health consumers are increasingly empowered to spend their health premium dollars on payers of their choice. Payers responding effectively to consumerism's forces will have an advantage in attracting today's health consumer.


Crafting an effective response requires payers to Understand the transformational power of health consumerism and begin to assess gaps between concept and execution.

Assessing Six Consumerism Dimensions

Critical capabilities in six key dimensions determine whether and how well payers respond to consumerism:

  • Front Office. Providing consumers the comparison shopping, pricing transparency and ease of use they demand across platforms.

  • Member acquisition and sales. Ensuring a seamless transition from the shopping process through closing.

  • Contact center. Providing intelligent, data-driven customer support both automatically and in person, as the customer requires.

  • Back office. Automating consumer- and exchange-facing processes to ensure smooth back-end processing of enrollments, changes, billings, etc.

  • Member retention and analytics. Generating a 360-degree view of members to support customer service as well as to anticipate customers' needs for new or different products and services through their membership lifecycle.

  • Product modularization. Offering consumers ability to create their own benefits plan with dynamic back-end pricing and real-time quotes.

Figure 1

Determining whether a payer has the capabilities detailed in the chart above requires a detailed assessment of very specific functions and the result for doctor's office reception consumers when those internal and external functions and workflows intersect (or don't) across the dimensions.

  • Ensuring the front office meets consumer demands for a seamless, consistent experience across Web and mobile interfaces requires responsive Web and advanced user experience design, as well as a portal, transparency tools and social integration.

  • Ensuring customer details are accurate and available whether customers access them via a Web portal or a telephone call require payers to eliminate data silos, use predictive analytics and support several tiers of contact methods.

  • Creating modular products with real-time pricing requires the payer to understand how health reform's new risk adjustment rules affect group margins and to have optimized the actuarial value of products to present the most appropriate offerings to the right targets at the right time.

We have developed a Consumerism Index™ tool that enables a deep evaluation of capabilities in each of these dimensions. It also enables us to gain a broader perspective about consumerism responses across the industry. This, in turn, helps interested parties compare and rank capabilities among payers. Today, social media listening is a basic capability. Leveraging social media as a marketing channel is industry-leading territory. Click2Chat is a baseline offering. Superiority is achieved with real-time speech analytics that identify signals during a conversation that a prospect is right for a new service or a member is ready to leave the plan and that prompt a service representative to take appropriate actions.

Front office capabilities ranked by health industry standards.

Figure 2

With the assessment completed and skills and capabilities gaps identified across the six dimensions, payers have the critical insights necessary for Step 3: Transform, the re-architecting of the enterprise to deliver consumer-driven products and services through customer-centric processes and professionals. We'll examine the roadmap to transformation in our next and final installment.

Read our white paper Operationalizing Customer Centricity for more about the capabilities required to satisfy customer demands for products, services and experiences from payers. Or visit Cognizant's Healthcare practicefor more insight.

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Healthcare Consumerism: Assessing Consumerism Capabilities