Five ways to ensure a consumer-centric health plan
By Sarah Rittman
Fueled by the continued escalation of medical expense and use, as well as the pressures of legislative reform, most health plans have recognized that their traditional wholesale business model will not allow them to succeed in the coming years. To manage medical expenses more effectively, appeal to the new individual market, and attract and retain the right portfolio of business risk, health plans must put much more focus on delivering value to the individual – the health-care consumer.
Some of these industries have practiced consumer-centric models for years; others have transformed themselves in much the same way the health insurance sector will attempt in the coming years.
“Unwavering commitment” means that top management understands why consumer engagement is so important and evangelizes the concept at every opportunity.
It also means that management at all levels adheres to a specific consumer-centric strategy and aligns operating model choices to support that strategy. Cross-functional sponsors believe in the cause, understand their role in achieving success, and are actively involved; and enterprise goals and divisional and individual incentives and compensation align with desired behaviors and outcomes.
While “commitment” may sound like a basic concept, it may be one of the most challenging components of the transformation for health plans to tackle. For example, within any health plan today there are likely significant disagreements around who, exactly, is the customer. Is the customer an employer group? A consultant? A broker? Or the end health care consumer?
In order to move forward with an effective consumer-centric strategy, it is absolutely critical to agree and commit to a single definition of the customer and a single customer-centric strategy. This agreement and commitment will serve as a solid foundation on which to build strategy and capabilities required to move forward.
Trust the facts
Again, theoretically this sounds like a no-brainer: Consumer-centric companies trust their data, and they use information to drive business strategy and decisions. It shouldn’t be that hard, right? Well, unfortunately, in an industry that has often made decisions for consumers based on what’s been requested by an employer or a consultant – not by the consumer himself – insights about customer preference and value don’t exist the way they do in other industries.
Since the insights don't exist, it is impossible for business leaders to trust information to guide their decisions. Over the next 12 to 18 months, plans must be able to build products, programs and service strategies based on the value they deliver to an individual consumer, not a group or consultant. To enable this competency, trust in fact-based decision making is a critical competency that plans must develop.
These organizations achieve “information trust” by pushing insights to all areas of the enterprise – and not restricting access to data and insights to analysts or technical people. For a health plan, that could mean scoring individuals for risk, propensity to respond, behavioral and attitudinal attributes, and preference – and keeping those scores at the fingertips of all business decision-makers.
Read from the same page
At the highest level, these functions and capabilities are broken into two categories: analytics and engagement. In most consumer-centric companies, relevant business capabilities around analytics and engagement methodologies are standardized and centrally managed, at least initially. Almost without exception, critical skillsets are leveraged across all business functions that manage elements of customer engagement.
To enable optimized use of these skillsets and resources, there is clear alignment around objectives and outcomes; and a willingness to say "no" to good ideas if they're not relevant for success.
From an operational perspective, feedback from all consumer communication touch points is captured and fed into a single repository to make sure the most effective modality, frequency and messages are utilized and all relevant outbound customer interactions are included in a centralized sequencing and prioritization methodology.
Keep the lines open and active
In consumer-centric companies, a wide variety of approaches to communication and engagement are deployed simultaneously in an effort to measure outcomes and adapt strategies as quickly as possible. The concept of “fail fast” is widely embraced in these types of organizations. Additionally, engagement methods are developed on a fact-based understanding of what consumers want, not what the organization “thinks” they want.
To enable this type of decision-making, automated feedback mechanisms are mandatory, and results of interactions must be incorporated almost immediately into consumer data and predictive models.
Consumer-directed marketing has typically been limited to initiatives driving acquisition and program engagement and has focused on just a few methods of outreach (primarily direct mail, telephone and e-mail).
In very few instances have the efficacy of these methods and the messaging they contain been truly tested and adapted based on outcomes.
Be sophisticated - and insatiable
These companies typically have an analytics team that is insatiable when it comes to searching for new, non-traditional data sources to power unique and previously uncovered insights.
They are not afraid to explore any and all new sources and are held accountable by their leadership for constantly improving data integration and quality.
As a result, these companies typically have better insight into – and agreement on – root cause; not just what is or isn't working, but the underlying causes. This foundation allows for much more sophisticated predictive analytics to take shape and to be fine-tuned over time.