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October 18, 2021

How to build digital health plan tools that members will use

To boost digital usage and member loyalty, healthcare payers need to prioritize investments in analytics, awareness, strategy and design, according to recent Cognizant-sponsored research.

We built it, but they didn’t come. Such is the lament of many healthcare payers that have invested heavily in digital health plan tools and capabilities for their members. Based on our 2021 Voice of the Member national survey, conducted in partnership with HFS Research, plan members are still slow to embrace the digital tools provided on payers’ apps and websites.

From our perspective, these lagging adoption rates are a result of payers underinvesting in awareness campaigns, analytics, strategy and design. Here are the steps payers can take to address these critical components of successful digital adoption.

  • Aggressively promote awareness of digital capabilities. Our research over the last six years has shown increasing enthusiasm among members for conducting health plan transactions digitally. Yet even when health plans build desired digital features, members don’t use them.

    Our current survey shows that in 2020, when telehealth use was growing by 24%, 39% of plan members used telehealth capabilities — but from third-party service providers, not their health plans. At least one reason why is that 40% of members said they didn’t know their plans offered a telehealth option.

    Payers must close these awareness gaps. Many do a poor job of promoting the tools they have, or they bury them several layers deep on their websites and don’t push them out to members when and where they need them most.

    While payers often tell us members don’t interact with them frequently enough to learn about their digital capabilities, the experience in the property and casualty (P&C) insurance industry negates that excuse. The average consumer has far fewer property and auto claims in a year than they do healthcare claims. Yet P&C insurers enjoy much higher digital adoption rates than healthcare payers do, according to our research.

    Why? P&C companies continually promote their apps and digital capabilities in their advertisements, websites, social feeds, etc. While they may use the apps infrequently, P&C customers do download them. Health insurers should similarly tout their digital capabilities in their marketing campaigns.

  • Make foundational investments in analytics. Payers won’t get the value they expect from digital initiatives without strong analytics. Analytics and intelligence are prerequisites to anticipating member needs and prompting them to use a digital feature or other next best action in an app or on a website. 

    Analytics are also invaluable for learning about member needs. For example, most payers view call center deflection as a win. Analytics can help achieve that goal by learning from data about why and when members call for help so that payers can anticipate and proactively address those issues. If the data shows nine out of 10 members contacting the call center for updated deductible data after an emergency department visit, that function can be built into an app or website and advertised.

  • Adopt business-led strategy and design for each digital initiative. Consumers today expect great digital experiences that payer tools don’t seem to deliver. However, health plan members reported unsatisfying experiences with payer tools, even when these tools offer self-service and other functions they want most, such as provider search and cost estimation.

    To avoid delivering disappointing member experiences, payers need to ensure the business, not IT, is leading these initiatives. In turn, the business must lead with in-depth strategy and design activities to ensure the digital capability meets actual member needs while creating business value.

    Whereas business-led digital development follows a rigorous methodology that includes creating personas and journey maps and using outside-in analysis for examples of how other industries deliver similar solutions, IT-led development often starts with technology selection, and then fits processes to the technology’s capabilities. The business-led approach fully scopes out member needs first. These needs then drive the technology architecture design and technology selections so that the technology serves the business vision vs. defining it.

    A large health plan we worked with took this approach to create new experiences for how brokers interact with members. We developed and designed personas, user journeys and eight future-state business processes before developing technology requirements.
  • Change funding mechanisms. It’s accepted practice today to spend heavily on implementation, while strategy and design efforts receive limited funds despite being prerequisites to successful outcomes. One organization we worked with was trying to build an industry-leading artificial intelligence model but lacked adequate budget to estimate ROI. Organizations must reallocate more budget to strategy and design efforts.

    Advances in platform solutions that minimize customization needs support this funding shift. Organizations also must redefine how they identify OpEx and CapEx spend because many strategy and design efforts (e.g., journey maps, process models, business architecture, etc.) are critical to building required future capabilities and may be capitalized.

Setting the stage for the future

Our study revealed a number of immediate investment priorities for payers, including tools for estimating procedure costs, looking up benefits, searching for providers, finding plan options, reviews and features, checking on claims status and calculating out-of-pocket expenses. But to realize high adoption and commensurate returns, payers must build these capabilities on a foundation of analytics and business-led strategy and design, followed by strong awareness campaigns.

By taking this approach, payers will set the stage for future member interactions that are more relational vs. transactional, such as health coaching, which will build loyalty and market share.

William Shea
VP, Healthcare Consulting
William Shea

William “Bill” Shea is a Vice President within Cognizant Consulting’s Healthcare Practice. He has over 20 years of experience in management consulting, practice development and project management in the health industry across the payer, purchaser and provider markets.

Jagan Ramachandran
AVP & Partner, Healthcare Consulting
Picture of  DIgitally Cognizant author Jagan Ramachandran

Jagan Ramachandran is an AVP & Partner in Cognizant’s Healthcare Advisory Practice. He leads with 20+ years experience at the intersection of healthcare business and technology, and he is an industry speaker on emerging healthcare trends.

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