How Personalization Improves the Healthcare Experience


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With the incredible amount of changes in the healthcare system, the search continues for the best ways to improve outcomes while reducing costs. One of the keys is for healthcare payers and providers to rethink how they engage with consumers, in ways that account for the shift to consumer-centric healthcare and the advent of disruptive business models. Retailers, creative partnerships between payers and providers like accountable care organizations (ACOs), and other non-traditional entities have further cut into the traditional market share of healthcare payers and providers, making the consumer experience an increasing differentiator in this competitive market.

It’s crucial that healthcare payers and providers adapt now. Recent research found that there is a more than $500 billion opportunity for a disruptor like Amazon to deliver a superior customer experience and create a new “front door” to healthcare, changing the first point of contact from a doctor’s office to a local drug store or the consumer’s living room.

Disruption in the healthcare industry will come quick and in many forms. Payer and providers are already seeing value-based care as a replacement for the fee-for-service model and increased risk-sharing between payers and providers, and that’s just the beginning. Combined with rising customer expectations and empowerment, as well as innovations in engagement channels and delivery models, it is clear healthcare payers need to make substantial changes. Personalization of the member experience through these five key business imperatives is a healthcare enterprise’s best way to prepare for the coming disruption.

Personalized Member Experiences: 5 Requirements

The way healthcare payers market to broad groups and individual consumers is and should be very different. Each consumer has their own communication preferences, with particular behaviors and attitudes that are specific to them. It is important for healthcare payers to fully understand this in order to create an effective personalized experience. To reach a customer segment of one, it is imperative for healthcare payers to alter internal processes by following these five requirements of personalized experiences.

1. Access All Data – To produce a personalized experience, it is essential for healthcare payers to have a deep understanding of their members. To gain that understanding, payers must unify member data from across the organization into a single customer view. Marketers within the healthcare industry recognize this need, with 55 percent of them working on systems to extend marketing’s view of the customer to include insights from all impact and interaction points along the customer journey, according to this recent survey. While doing this, it is important for healthcare payers to understand who owns the data they plan to use, and how to best access it with consumer consent. The fact that healthcare data ownership is spread among payers, providers, and even consumers creates a unique challenge. Since personalization is most relevant when driven from the full breadth of consumer, claims and clinical data, innovative approaches are crucial for healthcare payers.

2. Scale Personalization – After all the member data is unified into a single customer view, the next step is to determine how to personalize experiences at scale. This issue is found throughout the healthcare industry, with only seven percent of marketers able to leverage the in-line analytics necessary for the real-time decisioning that helps provide individualized experiences. Without the ability to personalize the member experience at an appropriate scale, using data-driven approaches and machine-learning where appropriate, healthcare payers will be ill-prepared to survive the coming marketplace disruption.

3. Adopt the Customer’s Cadence – Since consumer journeys are no longer linear, but are rather dynamic and multi-stage, it is imperative for healthcare payers to recognize that their members can engage through multiple online and offline touchpoints. Enterprises need to be prepared to engage with the real-time consumer based on an understanding of the consumer’s context, as they may have been through many touchpoints and stages before any one moment of engagement. Today’s consumers have heighted expectations driven by the likes of Netflix, Amazon and Uber, and consumers expect all enterprises to deliver highly personalized and relevant messages in the cadence they want and through the channel they choose.

4. Unite Technology – Technology silos tend to create friction in the consumer experience. The digital health network is more fragmented than ever as more than $18 billion has been invested in healthcare technology ventures in the last six years. A unified solution that connects all internal technologies, like a customer engagement hub, would counteract this friction. Adopting a flexible open garden approach to technology integration will also futureproof an enterprise, so they can adopt new technology as they continually innovate the consumer experience.

5. Provide the Best Experience – The modern consumer demands clear and immediate value, and healthcare payers need to understand that is the norm in the industry today. Disruptors that emphasize engagement, like leading brands, can overtake incumbents that have a lot of friction in their experience driven by silos of data, technology and services. The average customer does not care if personalization is difficult for an enterprise to deliver, they will migrate to those payers and providers that deliver a superior experience. To thrive, healthcare enterprises need to deliver a member experience that is on par with leading retailers.

The road to long-term growth can be built by achieving these imperatives. In fact, recent research found that personalization will push a revenue shift of some $800 billion over the next five years in retail, healthcare, and financial services to the top 15 percent of organizations who deliver the best personalized experiences. Only healthcare payers that personalize the member experience effectively will capture a portion of this revenue.

Influence of Personalized Experiences

Fragmentation across technology infrastructures and internal processes is a common among healthcare payers today. The disconnected technology stacks of driven by discrete channels, service lines and business functions are based on department-specific needs and have caused duplicated processes and disconnected member experiences. For example, a Medicare member could engage with different departments, through different channels, and have a varied and disconnected experience that ultimately causes confusion and frustration.

By adapting new processes and using innovative technology, healthcare payers can solve the problem of disconnected experiences and drive substantial benefits. Healthcare payers who personalize the member experience could also see five times higher retention rates, extending the value of personalization far beyond the immediate financial impact. This can be transformative for any healthcare payers and lead to breakthrough results.

The expectations consumers have of healthcare organizations are ever increasing; personalized experiences and access to the information they need when they need it have become the norm. The ultimate aspiration, however, is a closed-loop virtuous cycle where members engage with payers, who in turn use those engagements to further personalize the member experience. The healthcare payers that will be best positioned to endure the transformation happening in the industry, both now and in the future, will be the ones who are constantly looking ahead and evolving their member experience accordingly.


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