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Perspectives

Healthcare Consumerism: The Journey toward Transformation

2014-11-25


Healthcare consumers increasingly expect payers to deliver value, service and experiences on a par with those they receive from the best online retailers. As we've examined in this series, taking three steps will help payers respond to consumerism. First, by Understanding the level of consumer expectations and their drivers, payers can then conduct a thorough Assessment of the gaps between what customers expect and what payers can deliver. These insights are critical for Step 3, Transforming the enterprise to be customer-driven.

Healthcare consumers increasingly expect payers to deliver value, service and experiences on a par with those they receive from the best online retailers. As we've examined in this series, taking three steps will help payers respond to consumerism. First, by Understanding the level of consumer expectations and their drivers, payers can then conduct a thorough Assessment of the gaps between what customers expect and what payers can deliver. These insights are critical for Step 3, Transforming the enterprise to be customer-driven.


Figure 1

As previously noted, payers can begin designing their roadmap to transformation after assessing consumerism capabilities in the six key dimensions. The goal is to deliver consumer-driven products and services through customer-centric processes and professionals.

That's key: An effective response to consumerism is more than window dressing. We see payers today making incremental changes to existing products and layering new processes over old ones in hopes of becoming consumer-centric. These "workarounds", however, add complexity. They increase costs, hurt service and reduce agility.

Payers that instead choose to evaluate their processes from the big picture of customer value delivery will discover opportunities to reduce costs and increase efficiencies while delivering better products and services.

The Transformation Journey

Industry cost pressures are a key reason many payers attempt piecemeal approaches to consumerism, such as treating individuals as a "group of one" in hopes of filling new requirements with old group billing processes. Yet payers can reach important customer satisfaction milestones in cost effective ways:

  • Cost optimization and process improvements. Assuaging pain points for customers often requires rationalizing legacy systems to create efficiencies and reduce costs. This step can provide the financial flexibility needed for investing in next-generation technology

  • Product customization. Retail consumers want to compare product features and benefits and understand how their selections affect pricing with real-time quotes. Payers can start rebuilding products with modular components while they perform the unavoidable tasks of understanding how new risk adjustment and reimbursement factors change the member lifetime value calculation.

  • Contact center modernization. Consumers want effective self-service options and like communicating via instant messaging and e-mail. Using these preferred technologies can streamline and reduce the costs of contact center operations.

  • Customer engagement. The advent of "bring your own healthcare device" (BYoHD) offers payers valuable data streams to make wellness and care management programs more proactive and thus more effective at preventing expensive acute care episodes.

  • Data analytics. Analytics help payers anticipate member needs for new benefits and services as their life circumstances change, improving member retention and conversion rates (such as transitioning members from private health insurance to Medicare Advantage plans). Real-time analytics also make care and disease management programs more effective.

Payers can provide services like these to customers today without steep capital investment through a variety of hosted services offered by trusted service providers. Given that the power of the individual retail health consumer will only grow, payers must create effective strategies for meeting their requirements. The three-step model, Understand, Assess, Transform, provides a framework for payers to identify cost savings, process improvements and business opportunities they will gain by taking a broad response to consumerism.

Discover how transforming a key function such as utilization management can unlock resources for more valuable services like care management in this white paper, Elevating Medical Management Services to Meet Member Expectations. Learn more about the pressures to retool business processes to increase efficiencies and unlock business value in the new digital economy in our white paper The New Process Genome. Or visit Cognizant's Healthcare practice for more insight.

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Healthcare Consumerism: The Journey toward Transformation