Payer Accountable Care & Population Health Strategy
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The document discusses how payers must change their approach to better manage population health and accountable care. Specifically: - Payers currently only interact regularly with 20% of members through monthly bills, but will need to engage more members to improve outcomes. - The member experience needs to be omni-channel, interactive, cognitive, and mobile-first to better engage individuals. - The payer business model will shift from business-to-business to consumer-focused in order to retain and service more individual customers. - Payers currently do not have the right systems or data to effectively support individual members and need strategies to improve care, wellness, and population health management.
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Payer Accountable Care & Population Health Strategy
- 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. 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)
- 3. 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
- 4. 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)
- 5. 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)
- 6. 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)
- 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. 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. 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)
- 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)