Payers Must Reinvent member
experience to manage
Accountable Care & Population
Health
paul@palerhinoconsulting.com
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 80% of its members is a
monthly bill
The impact of member experience on Payers
A remarkable experience for every person
every time (on any device)

Member experience strategy must be:
• Omni channel
• Interactive
• Cognitive
• Employ mobile-first and design thinking.
A remarkable experience for every person
every time (on any device)
The impact of member experience on Payers

The Payer business model must move from B2B to B2C.
• The percentage of revenues from members will grow dramatically
• The relative cost to serve a member will be significantly higher
• The number of members touch points and interactions will grow
dramatically
• The existing sales model for individual policies will not work
• Customers will churn rapidly to get the best price, coverage, and customer
service
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.
• The number of individuals choosing where to buy insurance will increase
dramatically. That is the good news; that is also the bad news
• Given the chance, a majority of the self-insured would change companies
– Payers are not noted for:
• Taking care of customers
• Attracting customers
• Retaining customers
• 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 customers in:
• 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 drive 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 and is two-way
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)