payer aco and pop health strategy
TRANSCRIPT
A remarkable experience for every person every time (on any device)
Payers Must Reinvent Member Experience to Manage
Accountable Care & Population Health
A remarkable experience for every person every time (on any device)
Population Health & Accountable Care require payers to change their member experience strategy.
• 80% of member interaction comes from 20% of its members• The only interaction a payer has with the other 80% of its
members is a monthly bill• Most members don’t know what additional services they have
and even fewer take advantage of those services
The impact of member experience on Payers
A remarkable experience for every person every time (on any device)
To make accountable care and population health effective, member experience strategy must be:
• Omni channel (phone, portal, social media, text, email)• Interactive—from member to payer and from payer to
member• Cognitive• Employ mobile-first and design thinking
The impact of member experience on Payers
A remarkable experience for every person every time (on any device)
The Payer business model must move from B2B to B2C.• Customer service must become the dominant business
strategy• The percentage of revenues from individuals will grow
dramatically• The relative cost to serve a member will be significantly higher• The number of member interactions will grow dramatically• Member churn will increase
Payers will sell, deliver, and support individual policies that more closely resemble the wireless industry (long-term contracts).
The impact of member experience on Payers
A remarkable experience for every person every time (on any device)
The Payer business model and customer experience strategy is not prepared to move from B2B to B2C.• Taking care of members will be the competitive advantage• Individuals will choose their payer• Members will change payers• Exceeding member experiences must become a business
imperative
The impact of member experience on Payers
A remarkable experience for every person every time (on any device)
Payers’ systems and processes are not designed to effectively support significantly more individual members with:• eCare• eCommerce• Mobile channels• Customer portals• Call centers/CRM• Business development, Sales & Marketing• Payment & Collections• Claims & Disputes
The impact of member experience on Payers
A remarkable experience for every person every time (on any device)
What payers know about individual members:• The treatment or procedure for which a member submitted claims• The medications a member received • Health history• Whether the member paid their bill
What payers know from the combined analytics of all of their members:• Big Data only reflects the combined health data of all members• Analytics forecasts the likelihood of segments of the population to
develop certain conditions• Analytics forecasts health trends
The impact of member experience on Payers
A remarkable experience for every person every time (on any device)
What payers don’t know about individual members:• Whether the member’s treatment or procedure was
effective• Whether the member took their medication and adhered to
it• The health of a member who has not filed a claim• The lifestyle of the member• The current health and wellness of the member
Knowing how someone was does not reflect how someone is.
The impact of member experience on Payers
A remarkable experience for every person every time (on any device)
To improve accountable care, population health, and Star ratings, payers must:• Improve member access to improve engagement• Provide a remarkable user experience that is available every
time, at any time, and on any device• Capture, monitor, and assess health data that reflects a
member’s current health• Design an engagement platform across multiple channels that
is available 24 x 7, is two-way, and is cognitive
The impact of member experience on Payers
A remarkable experience for every person every time (on any device)
Payers must design strategies, processes, and systems to improve care and wellness.• Assess which strategies, processes and systems will be
impacted• How will this impact a Payer’s digital strategy?• How will this impact a Payer’s mobile strategy?• How will this impact a Payer’s call centers and CRM?
What Should Payers be doing now to be ready?
A remarkable experience for every person every time (on any device)
The following slide depicts a high-level approach to recasting consumerism, access, and engagement.
How We Approach Recasting Consumerism
3 Steps To Innovate Consumerism, Access, & Engagement
Define Enterprise-Wide Access/Experience
Strategy
Implement InteractiveDigital Access
Implement EffectiveVoice Access
Create and implement an omni-channel (voice & digital) access and engagement strategy using user-centered-design
• Understand how stakeholders access & engage today
• Meet with executives and their stakeholders to define their requirements
• Create stakeholder personas & journey maps
• Define a vision for access and experience
• Define the access & engagement GAP
• Create the roadmap for change
• Assess the digital effectiveness
• Assess the benefits of an interactive and cognitive digital, mobile-first, and social media strategy
• Evaluate creating a consumer portal in addition to the patient portal
• Evaluate the findings• Define an implementation
roadmap• Implement the roadmap
• Assess the effectiveness of the call center(s)
• Recommend what can be improved & the process and technology that should be included
• Evaluate the value of the recommendations
• Define an implementation roadmap
• Use user-centered-design to design a more effective call center experience
• Implement the findings