Sharpening Focus on the Future of Payors

Regulation

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November 6, 2018

Disruptive mergers, partnerships, joint ventures, and operating models built for rapid growth have become business as usual across the payor landscape. In an age when traditional healthcare consistently lands at the bottom of the American Satisfaction Index, a growing number of “InsurTech” disruptors are emerging to provide the more seamless, connected experiences that meet expectations shaped by interactions with retail, financial services, and other leading consumer industries. Against this backdrop, the imperative for legacy health insurers is clear: to remain relevant, they must transition from transactional relationships with members and providers to holistic health partners that add value throughout their member’s life journeys that extended beyond basic care.

Last month, I had an opportunity to advance the discussion around payors’ future at the Health Plan Consumer Experience and Retention Summit in Boston. The Summit brought together cross-functional executives—from clinical to business development—in a forum to discuss best practices, learnings, and insights with other leading healthcare organizations

Discussions across a series of speakers, case studies, and networking events over the course of the two days illuminated the approaches and tactics that healthcare leaders can apply when creating strategies and designing experiences that promote better health outcomes and satisfaction for members, organizational resiliency, and increased business value (e.g. profitability):

  • People, not patients: Human-centered care and experiences tailored to each person’s goals and lifestyles are paramount to the “care personalization” that consumers expect. Terms such as “patient experience” can carry a negative connotation as they overlook the fundamental, multi-dimensional aspects of being human.
  • Personalization Everything! Whether the topic was new models of care, digital engagement, marketing, or financials, personalization was covered in about 90 percent of the conference’s discussions and presentations. Effective personalization will require healthcare leaders to move beyond segmentation and identify human-centered ways to tailor experiences that meet unique lifestyle needs. But before organizations can move to personalized experiences, they must first focus on the fundamentals and meet baseline expectations of their consumers that are “table stakes” in other industries.
  • Healthcare finance: In U.S. healthcare, about $765 billion is wasted each year, and costs are growing at a rate that exceeds inflation. There’s no doubt that healthcare costs are unsustainable, and financing will be a focus in 2019 and 2020 for advanced payors and systems. JP Morgan Chase is one leading firm advancing this discussion. For some consumers, financial situations are causing “deferred care” in response to increasing out-of-pocket personal expense. Healthcare companies have an opportunity to elevate and address these issues by placing a balanced focus on care and the financial experience.
  • Payors as enterprise orchestrators: Payor responsibilities should extend beyond care managers. In fact, they have an opportunity to lead the next wave of healthcare disruption by extending into social services to provide a variety of support for members such as childcare and home loan payment assistance—ultimately being the catalyst for this change. Too often, people are forced to make difficult trade-offs between things like childcare and meeting the deductible for a medical procedure. Health insurers have ability to be advisors by understanding member’s personal situations.
  • Member transitions: There was a heavy focus on members’ increased movement from plan-to-plan e.g. traditional plans to ACOs and commercial to Medicare Advantage. In an age when members’ expectations are increasingly shaped by their other consumer experiences, payor executives must crack the code on creating seamless and connected experiences for those in transition. Health insurers must take on the role as the “educator” and “shepherd” to provide seamless experiences.
  • Equip and empower employees: The member’s experience is largely a product of their interactions with employees. Employee experience frequently surfaced as a topic to drive customer-centered transformation. For mature and experienced payors and systems, this focus area is especially critical to taking a “good” customer experience to “great”.

As health plan leaders’ future vision comes into focus, there’s an opportunity to design strategies that are grounded in the principles of personalization, holistic care, and investments that add measurable value at key junctures along the member journey – such as during health plan transitions. My participation in the Health Plan Consumer Experience and Retention Summit served as a poignant reminder that while disruption is knocking across the healthcare landscape, there’s power in collective discussion and ideation that promotes health plan leaders’ ability to learn, adapt, and innovate.

Click here to learn more about the Tenth Annual Health Plan Consumer Experience and Retention Summit.

© 2018 THE NORTH HIGHLAND COMPANY.