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Health Payers Targeting Improved Consumer Experiences in 2019

Consumer expectations are changing and health payers are keenly interested in meeting them.

Health payers and consumers

Source: Thinkstock

By Kyle Murphy, PhD

- Improving the consumer experience is top of mind for health payers heading into the new year, according to a multi-industry survey of senior leaders by North Highland.

“The concepts of culture and change are often at the foundation of many of the operational performance issues we’ve observed with clients,” said Tina Ehrig, Managing Director and Global Healthcare Lead. “To enhance a health plan’s operational performance, we need to start with assessing these challenges through the lens of cultural change.”

Of the 100 leaders from health payers, 84 percent indicated that customer experience and a delivering consumer-centric approach was the top strategic priority heading into 2019. However, only 14 percent of respondents reported being prepared to address this priority.

A similar percentage of respondents (83%) pointed to data and analytics, with 17 percent reportedly prepared.  Meanwhile, 81 percent listed organic growth as a top health payer priority in the coming year, with one-quarter more than adequately prepared.

“Following a period of heavy consolidation in the industry, payors have access to unprecedented relationships, channels, and capabilities. These new synergies are driving positive sentiment in the industry,” stated the authors of the survey.

In 2019, payers are also interested in generating new revenue sources through product and service development and entering new markets, the two priorities rounding out the top five at 80 percent apiece. While operational excellence trails consumerism, data analytics, and organic growth, not a single respondent claimed to feel prepared to address this challenge head-on.

 “As with many other industries, people and resources and knowledge and skills are the two most common barriers to addressing strategic priorities. The perceived value of customer-centricity/experience and product/service innovation necessitates a focus on enlisting the proper talent to usher in more cutting-edge customer-facing technologies,” the authors noted.

Customer expectations clearly represent the impetus behind these priorities and the changes to business expected for next year. The survey authors offer two recommendations:

  • Think beyond data for risk and population health management, and shift your focus to member insights on the service side of the business.
  • Consider the ways that member-facing data and satisfaction scores can enable the product/service innovation that will move the needle on member experience.

Come January, the emphasis is on seeing the forest for the trees, the individual patient among the population, to ensure a positive experience for all consumers.

According to North Highland, payers will need to address challenges related to people and skills to have success over the next twelve months. To that end, these organizations will make talent acquisition a major component alongside efforts to improve their products and services.

For the authors of the survey, recommendations flow from an understanding that backend activities play as crucial a role as those on the frontend.

“Orient your organization around value and outcomes, as opposed to de-centralized functions that focus on vertical activities,” they write. “By reducing procedural restriction points, automating interchanges, and eliminating siloes between functional teams, organizations will be more holistically accountable to the needs of the member. They’ll also be better positioned to design customer-centric solutions and services.”

The language of value-based care peppers the data and insights pulled from its survey. Mirroring integration efforts on the provider and care-delivery side of things, payers are increasingly looking beyond their own organizations at work underway elsewhere.

By transforming volumes of data into actionable information, payers are developing approaches to delivering quality healthcare at the scale of populations while ensuring that they meet the unique needs of individuals.

“Powering customer experience (CX) transformations with data strongly supports the outcomes payor organizations are looking for, fantastic CX that cultivates growth, and paths to operational efficiency,” the authors highlight.

Historically, payers have set on large amounts of data showing the many touchpoints consumers have with the healthcare system. The challenge now turns to making sure these experiences meet their current needs and that their future expectations are likewise able to be met.


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