Laying the IT foundation for payer member engagement

In this new world of consumer empowerment, we hear a lot about how organizations need to engage individuals in an effective, efficient and personal way, in order to successfully provide a quality experience within the most cost effective manner.  Whether this is Starbucks, Amazon, Lyft or your local movie theater or cable provider, the more they know and understand about their customer and the experience they need to create, the stronger the relationship and successful the outcome will be.

The healthcare industry, including payers, are no different.  Having access to a multitude of information, a 360 degree view, and involvement with their potential and/or current member is important in order to provide a comprehensive solution and good experiences.  As a result of this new consumer empowerment, healthcare payers must also look at and design solutions for the member experience with the same retail mentality of some of the previously mentioned companies.

To maximize their efforts in creating this consumer experience, healthcare payers will want to examine their processes, systems and communications and ensure that they have the information and transparency which allows their members access to health records, educational material, as well as provider costs, ratings, schedules and patient payments access, as examples.  In order to learn more about their members, and create the experience, disparate payer systems will need to be integrated in order to share information, and combine with data outside their control, as well as health information generated by the consumer.  As a result, data aggregation technology which understands interoperability standards and can easily integrate, normalize and present data, becomes so important.

This operational ability will assist in creating the necessary communications along the administrative, clinical and social touch points.

On the administrative side, for example, starting with a good experience during the enrollment and billing process is important in getting the payer/member relationship off to a good start.  A shopping-rich, flexible exchange where members can shop for and compare health plans, as well as other related products, and have accurate and timely information can provide that strong introduction. 

On the clinical and social sides, respectively, a strong care management framework and supporting technology is of strategic importance in order to develop the member touch points and analytics to determine which individuals are expected to need and benefit most from medical and psychosocial interventions.  The program should include a strong people and technology infrastructure, and be able to derive and deliver the needed communications, when, how and where, so as to keep the individual well, recovered, informed and empowered.

The bottom line is that just trying to react to new government policy or regulation being pressed upon their organizations is not enough in this changing member expectations environment.  It is in the interest of healthcare payers to have the necessary processes and technology to be out front of and play a prominent role in the health and wellness development of their members.  It is important that they be proactive and not reactive to stay ahead of individual medical needs, so as to educate members and control costs in both the short and long term.  So welcome to the continued growth of the digital (r)evolution.  In the long run, organizations and members will be better for it.



About the author:  Mike Fontana is a practice lead within the Dell Services Health Plan Innovation & Consulting team and a member of the HIMSS Revenue Cycle Improvement Task Force.