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Perspectives

Healthcare Consumerism: Understanding Its Drivers

2014-11-20


Empowered by healthcare reform and the freedom to spend their insurance premium dollars on payers' choice through health exchanges, consumers want better products, higher quality service and a better overall experience with payers.

Empowered by healthcare reform and the freedom to spend their insurance premium dollars on payers' choice through health exchanges, consumers want better products, higher quality service and a better overall experience with payers.


As we explained in our introduction to this series, Healthcare Consumerism: The Rise of the Empowered Healthcare Consumer, health payers can create value from this trend by taking three key steps: Understand, Assess and Transform.

The first, perhaps deceptively simple step is to understand what is driving consumerism. Fully comprehending the forces shaping consumer expectations of payers is a prerequisite to conducting a useful and honest assessment of capabilities in Step 2.

In short, consumers want healthcare payers to deliver the same experience and service they have been trained to expect from the best online retailers. Think about what top online retailers offer: personalization; many product/service innovative healthcare choices; peer reviews; fast service; easy return and refund processes; consistency across platforms; easy access to account data.

In the health payer world, consumers translate these to:

  • Ability to customize plan benefits and easy comparison of different plans, with real-time cost data calculations.

  • Access to reviews of plans and payers by peers.

  • Coverage for alternative health therapies.

  • Intelligent self service options that work on PCs, tablets, smartphones and provide anytime, anywhere health plan data access.

  • Well informed, empowered customer service professionals.

  • Proactive offerings of personalized services based on customer history.

  • A seamless experience across the membership lifecycle, such as when switching between plans as life circumstances change.

Figure 1

Retailers lead consumers' expectations for customer-centric services; health insurers occupy the bottom quadrant.

From a consumer perspective, payers aren't effectively matching retailers' performance. Consumers find shopping for healthcare insurance to be a confusing, frustrating process due to industry jargon (co-pay vs. co-insurance, anyone?); inefficient processes, such as launching enrollment online then having to complete it via snail mail; poor customer service with only pieces of a customer's record available to the agent.

Figure 2

Why does solving these issues matter so much now? Because the individual health consumer has increasing power and choice over how and where they spend their healthcare dollars:

  • Growth of exchanges. The federal and state health insurance exchanges enrolled approximately 7 million individual health plan consumers for plan year 2014. We expect the exchange-based market to grow as employers embrace it as an option for controlling their healthcare costs and as more individual purchasers turn to exchanges to compare plan options.

  • Employer cost shifting. Private exchanges offered by employers will become popular (as we describe in our white paper, Reducing Costs, Increasing Choice). More employers will offer employees a lump sum with which to purchase health plans on a private health insurance exchange.

  • New options. New care delivery and reimbursement models are emerging to compete for the individual consumer's business, such as hospital owned-and operated Accountable Care Organizations (ACOs).

The bottom line is that payers that don't meet consumerism demands will lose business to those that can.

Yet a payer consumerism strategy is not just about meeting consumers' expectations for a great online shopping and service experience. It is also about engaging customers to manage their own health and wellness and anticipating their future plan needs. Activity trackers and in-home health devices produce a wealth of data payers could use to offer effective personalized coaching to members. It's that extra level of engagement and service that will build strong brand and customer loyalty.

The next step payers take toward those goals is to assess the gap between the products and services they offer today and what consumers demand. That requires analysis of six key dimensions, which we'll examine in Part 3, Healthcare Consumerism: Assessing Consumerism Capabilities, in this series.

Read our white paper Turning the Vision of Connected Health into a Reality for more information about how consumers are using home health technology and ways payers can connect with them. Also see our series on Code Halos for more about how forward-looking companies are using data to meet customer expectations. Or visit Cognizant's Healthcare practice for more insight.

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