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Payer aco and pop health strategy

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What every healthcare payer needs to know in order to implement accountable care and population health

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Payer aco and pop health strategy

  1. 1. 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)
  2. 2. 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)
  3. 3. 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 A remarkable experience for every person every time (on any device) The impact of member experience on Payers
  4. 4. 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)
  5. 5. 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)
  6. 6. 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)
  7. 7. 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)
  8. 8. 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)
  9. 9. 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)
  10. 10. 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)
  11. 11. The following slide depicts a high-level approach to recasting consumerism, access, and engagement. How We Approach Recasting Consumerism A remarkable experience for every person every time (on any device)
  12. 12. 3 Steps To Innovate Consumerism, Access, & Engagement Define Enterprise-Wide Access/Experience Strategy Implement Interactive Digital Access Implement Effective Voice 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

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