Implications of reform and healthcare transformation:
The healthcare reform, regulatory mandates and increased transparency puts tremendous pressure on health plans to focus on members’ and customers’ needs.
- Significant opportunities exist for health care companies who can help employers and consumers find the right answers
- Shift in risk from health insurance companies to consumers and hospitals sharing the risk will require Health Plans to provide greater transparency in cost and quality information
The key to winning and engaging customers for an extended period of time will require providing greater transparency to consumer in cost of care, billing, personalized actionable information, access to information on preventive care, and wellness. A vast amount of data is created with proliferation of devices and capturing clinical data to improve care. It will be important for Health Plans to transform this data into actionable information to improve customer experience which will lead to improved consumer engagement.
An improved customer engagement model would require attaining single source of truth, on customer 360, calculating risk scores, and longitudinal view of customer records for orchestrated targeted outreach. There needs to be a major transformation in customer experience and engagement. Factor multichannel into the customer journey: member interaction with CSR at the call center, a text message, a push notification, an email, Facebook ad, a direct mailing. Today’s customers engage and interact through multiple channels. They expect all the channels to be personalized and pick-up where the last experience left off. The customers expect one seamless experience.
The current Health Plan organization is lacking integrated customer 360 data, does not have most current data, is reactive and not proactive due to lack of data and technologies, the back-end systems are not channel agnostic, does not support self-serving customer support and predictive technologies. The systems are driven from claims data which is retrospective rather than prospective.
Health Plans will need to invest in tools and technologies that will transform their organization customer experience by making sure that the context of consumer engagement is consistent across all channels, customer gets consistent information through all channels.
Healthcare Consumers are engaging through multiple channels – web, social media, IVR, call center. Health Plans must improve Consumer Engagement by providing all channels with the context specific information to the right person at the right time. Health Plans needs to segment consumers by their health risk scores, utilization scores, cost scores, patient activation measure (PAM) score to generate targeted personalized actionable information.
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