Personalize the Member Experience to Improve Results

John Nash | June 21, 2018

Member Experience

The shift to consumer-centric healthcare is forcing healthcare payers and providers to rethink how they engage their members. Retailers, creative partnerships between payers and providers like accountable care organizations (ACOs), and other non-traditional entities have further cut into the traditional market share of healthcare payers and providers, which has made healthcare a more competitive industry.

Yesterday at AHIP Institute & Expo 2018, I spoke alongside Melissa Cellucci, vice president of business development at GuideWell Connect, a leading provider of consumer sales, marketing, and engagement solutions to health plans. We discussed these changes in the marketplace, and provided advice to healthcare payers looking to adapt. It is crucial that healthcare payers adapt now, especially given the scale of the coming disruption. Recent research found that there is a more than $500 billion opportunity for a disruptor like Amazon to deliver a superior customer experience and create a new “front door” to healthcare, changing the first point of contact from a doctor’s office to a local drug store or the consumer’s living room.

Healthcare disruption will come in many forms, including value-based care as a replacement for the fee-for-service model and increased risk-sharing between payers and providers. Pair this with rising customer expectations and empowerment, as well as innovations in engagement channels and delivery models, and it is clear healthcare payers need to make substantial changes. The best way to weather the coming disruption is through personalizing the member experience, which requires taking action in five key areas.

The Five Imperatives of a Personalized Member Experience

To provide a personalized member experience, healthcare payers need to understand that marketing to individual consumers is far different from marketing to broad groups. Each consumer has their own communication preferences, with specific behaviors and attitudes that are relevant to them. This requires altering internal processes to reach each consumer as a segment of one, which can be achieved by pursuing five key business imperatives:

  1. Bringing All Member Data Together – Healthcare payers need to have a deep understanding of their members to deliver personalized experiences. To gain that understanding, payers must unify member data from across the organization into a single customer view. Healthcare payers largely recognize this need, which is why 55 percent of marketers in a recent survey are working on systems to extend marketing’s view of the customer to include insights from all impact and interaction points along the customer journey. While doing this, healthcare payers need to understand who owns the data they plan to use. Healthcare has unique challenges, as data ownership is spread among payers, providers, and even consumers. Healthcare payers must take innovative approaches to build an effective single customer view.
  2. Personalizing the Member Experience at Scale – Once member data is unified into a single customer view, healthcare payers need to determine how to personalize experiences at scale. This is a cross-industry issue, with only seven percent of marketers able to leverage the in-line analytics necessary for the real-time decisioning that helps provide individualized experiences. Without the ability to personalize the member experience at an appropriate scale, healthcare payers will be ill-prepared to survive the coming marketplace disruption.
  3. Operating at the Speed of the Customer – The customer path to purchase is now dynamic and multi-stage, instead of a linear journey. Healthcare payers need to recognize that their members can engage through multiple online and offline touchpoints and adjust accordingly, which means having the ability to meet members at the cadence they want through the channel they choose.
  4. Connecting All Internal Technology – Over the last six years there has been more than $18 billion invested in healthcare technology ventures, creating a digital health network that is fragmented and full of friction. Healthcare payers need to counteract this by connecting all their internal technologies to a unified solution, like a customer engagement hub, which can also futureproof their infrastructure through adopting a flexible open garden approach to technology integration.
  5. Delivering a Superior Customer Experience – Healthcare payers need to understand that the modern consumer wants value and they want it immediately. The difficulty in delivering that experience is immaterial to the average customer, which is why there is an opportunity for disruptors like Amazon who emphasize engagement. Healthcare payers need to deliver a member experience that is on par with leading retailers to thrive.

Achieving each of these imperatives puts healthcare payers on the road toward long-term growth. This is especially important because recent research found that personalization will push a revenue shift of some $800 billion over the next five years in retail, healthcare, and financial services to the top 15 percent of organizations who deliver the best experiences. Only healthcare payers that personalize the member experience effectively will capture a portion of this revenue.

The Direct Impact of a Personalized Member Experience

Most healthcare payers right now have substantial fragmentation across their technology infrastructures and internal processes. The disconnected technology stacks of groups like marketing and telesales, which evolved based on department-specific needs, have caused duplicated processes and disconnected member experiences. The same Medicare member, for example, may engage with different departments depending on their needs. That member then receives a disconnected experience that ultimately causes confusion and frustration.

Solving the problem of disconnected experiences through innovative technology and process adaptation can drive substantial benefits. One of GuideWell’s customers who undertook a personalization initiative, for example, enjoyed a 20 percent increase in effectiveness of member engagement and 20 percent lower costs. Healthcare payers who personalize the member experience also enjoy five times higher retention rates, extending the value of personalization far beyond the immediate financial impact. This can be transformative for any healthcare payer’s longevity.

Consumers increasingly expect their experience with healthcare organizations to be personalized, allowing them to access the information they need when they need it. This ultimately needs to take the shape of a closed-loop virtuous cycle where members engage with payers, who in turn use those engagements to further personalize the member experience. Healthcare payers who evolve their operations now, before disruption shakes up more of the industry, will be well-positioned to weather the transformation happening in the industry now and in the future.

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John Nash
John Nash

John Nash has spent his career helping businesses grow revenue through the application of advanced technologies, analytics, and business model innovations. As Chief Marketing and Strategy Officer at RedPoint Global, John is responsible for developing new markets, launch new solutions, building brand awareness, generating pipeline growth, and advancing thought leadership. Connect with John on LinkedIn.