The Importance of Identity Resolution in Healthcare

Patient and Dr telemedicine session

After listening to the Q2 earnings calls of several health insurers, Forrester discovered some commonalities in terms of their priorities and investment strategies. Among its key takeaways was that there is a growing pressure for health insurers to “up their game” in the area of customer experience, spurred by the entry of retail giants Amazon, CVS and Walgreens in the space, but also because of consumer expectations that the overall health experience more closely resemble the retail experience. That is, a demand from consumers for ease, immediacy, control of data and transparency that is pressuring payers – and providers – to be more proactive in guiding the consumer healthcare journey.

One challenge for healthcare organizations to meet these expectations is that healthcare lags behind retail in terms of creating seamless digital experiences that recognize a patient or a member as the same individual across multiple channels, and integrating those experiences with offline journeys. Whether online or offline, inbound or outbound, healthcare consumers want caregivers, payers and other stakeholders vested in their well-being to know them as the same person. This recognition includes personal information as well as medical history, chronic conditions, prescriptions and medication adherence, care gaps, etc.

To fulfill consumer expectations for a consistent, omnichannel personal understanding, healthcare organizations are increasingly interested in identity resolution. Key use cases for deploying identity resolution capabilities include omnichannel orchestration (delivering a consistent experience across channels) and next-best actions (real-time decisions activated in concert with an individual consumer healthcare journey).

Knowing all that is Knowable

For a basic example of why healthcare organizations are interested in identity resolution for the purposes of omnichannel orchestration and delivering a next-best action, consider a member of a healthcare plan who engages with a provider for a digital visit (i.e., telehealth or online chat with a provider). With the verified identity the provider can personalize content and next best actions, like closing a care gap or scheduling a wellness visit. If we think of a holistic healthcare experience as an ongoing conversation between a consumer and everyone vested in the consumer’s care – primary care providers, specialists, payers, pharmacists, etc. – identity resolution is one of the foundational requirements for all stakeholders to have the same view of the consumer.

The delivery of a real-time, personalized experience might also mean that in addition to having an updated, real-time view of claims and clinical data, a provider can also see information about the individual’s risk tolerance, disposition to telehealth options, access to transportation for the purpose of scheduling appointments, the member’s ability to pay, and other social determinants of health. Providers have exceptional clinical analytics for world-class diagnostic and treatment capabilities, but outside of a clinical setting the majority of providers know little about their patients. It’s not that they don’t care; of course the health of their patients is paramount. The issue is that they don’t have the behavioral, preference and consumer data to better inform an omnichannel next-best action that factors in the entirety of a healthcare journey.

Identity resolution is a key component for creating a golden customer record, a single customer view that combines a full identity graph with full contact history, all attributes and all aggregations. A Golden Record provides healthcare professionals with up-to-the-moment, highly accurate and reliable information about a healthcare consumer that extends beyond clinical data. Channel preferences, social determinants of health and risk tolerance are among the signals included in a persistently updated Golden record that, once activated, yields personalized experiences on any channel, at any time.

One Identity, One Platform

From a technology standpoint, providers and healthcare systems may have multiple electronic medical records (EMR) systems that are siloed by care units, networks or hospitals. But when it comes to marketing, the majority of health systems use solutions or platforms that are not HIPAA-compliant, meaning they’re aggregating personal, non-PHI data. A personalized experience, then, is limited to a member’s name, age, address, etc., precluding health information that would otherwise provide marketers with a full identity graph, allowing them to deliver a more personalized experience and, ultimately, drive better outcomes.

Consider another example of a healthcare organization wanting to close a care gap for colorectal cancer screenings. Aggregating an audience off a marketing database, the organization sends an email to men and women turning 50 urging them to schedule an appointment. The email may meet the low standard of “personalization,” but it could improve outcomes considerably with a complete identity graph; matching the recipient to a specific provider, recommending optimal times, offering transportation options to someone who doesn’t drive, or providing payment arrangement information to a low-income member. Perhaps there are other care gaps that need to be addressed, or the member has a child at home due for an annual wellness check. Furthermore, perhaps email is not the ideal channel for a percentage of the audience that responds better to a call, an SMS or a video consultation.

When a health organization knows all that is knowable about a patient or member through a Golden Record, it can leverage advanced segmentation rules based on current health condition, social determinants of health, etc., to allow for a more efficient and effective personalized message to key segments that return the most value for a health plan or provider group.

This ability is of particular importance for value-based care (VBC) reimbursement models. If a member’s financial value to a health plan provider is worth a certain amount in annual premiums, the insurer may contract with a provider for a smaller financial reimbursement (e.g., 20% of the overall maximum value) if the member stays healthy; that is, she schedules preventive screenings, takes prescribed medications as directed, follows a nutrition plan, etc.

In a VBC model, there is a direct revenue link between hyper-personalized content through advanced segmentation and improving health outcomes.

A Next-Best Action with Every Engagement

Identity resolution enables healthcare organizations to accomplish both omnichannel orchestration and the delivery of next-best actions by providing them with everything there is to know about a healthcare consumer’s identity in one marketing platform, including first-party data, channel preferences, devices used, household status, life stage, etc. Communication with a patient or member is based off an entirety of signals and behaviors, and real-time engagement is enabled across an entirety of channels as the healthcare consumer traverses them. Importantly, triggered events can be on an inbound or outbound dynamic.

The email example is a common outbound marketing tactic, but a full identity graph that includes a consumer’s devices, social media, phone numbers, online session behavior, etc. can also identify an inbound consumer. Perhaps a member has received a IVR call to schedule an appointment but decides to schedule online instead. With a single customer view, a payer or provider recognizes the individual – even without logging into a member portal – and can personalize the online content, making it hyper-relevant for an individual health care journey.

Drive Better Outcomes with Personalization

In a 2021 Harris Poll on customer experience, consumers ranked healthcare third (behind retail and financial services) in terms of providing a consistent experience that demonstrated a personal understanding of a consumer. Yet when asked which industries should provide the most consistent experience and customer understanding, healthcare polled first. In addition, in a recent survey from health technology vendor Welltok, 80 percent of consumers said they are more likely to follow a treatment plan if it is personalized.

These and similar results show why identity resolution is emerging as an important capability in the healthcare space. More organizations are adopting VBC business models where it becomes important to maintain a consistent dialogue with a patient or member across physical and digital channels in order to deliver next-best actions optimized for an individual healthcare journey.

Maintaining a consistent dialogue requires that a digital healthcare experience is similar to an experience a healthcare consumer would receive in a clinical setting, such as an appointment with a provider. That’s the expectation consumers have. To meet it, healthcare organizations must orient a seamless experience around the consumer – using all relevant data that form a single view of the healthcare consumer.

For more on how identity resolution can help your organization deliver better health outcomes with a more personalized customer experience, click here or here.

Related Redpoint Orchard Blog

Put the Healthcare Consumer at the Center of Both Care and Education, Even Outside the Doctor’s Office

Healthcare Consumers Weigh In: Personalized Experiences are a Must

Align the Healthcare Experience Around the Consumer: How an Omnichannel CX Delivers Improved Health Outcomes

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