Viewpoints

Opinion and analysis on managing care from experts and KOLs

Health Plans Can’t Ignore The Customer Experience Any Longer


Erik Swanson

The health care industry, including managed care organizations, is notorious for ignoring the customer experience. But with regulations limiting differentiation between products, health plans must rethink consumer experience to meet expectations of today’s consumers, who seek convenience, quality, and speed from their health care organizations.

Many health plans understand they need to connect more effectively with their end customers, but technological, cultural, and other obstacles are in the way. One of the biggest challenges is the indirect nature of the relationship with members, as consumers typically access their health care through employers, hospitals, or doctors.

Value-driven care models present an opportunity for health plans to deliver superior customer service, but there’s also a risk that they’ll become even more removed from the customer if the models are viewed simply as a way to shift risk to providers.

On the technology front, most payers are just starting to explore technologies to collect data, drive customer insights, and manage customer relationships.

And at a cultural level, creating a truly memorable and high-quality customer experience requires a massive shift in thinking by all employees in an organization. High-performing organizations in other consumer-facing industries have technologies and employees at every level focused on providing an excellent customer experience. These organizations should become examples for payers to follow.

In the future, payers will have much more direct interaction with members. Informed patients will be making choices about their health care like they do any other purchase—by assessing cost, quality, and the experiences of other customers.

Because payers will become more integral to this process, now is the time to adopt the following four best practices:

  • Take a consumer perspective. Members have typically expected very little from their health plan. A member’s experience with his or her health plan only started when something went wrong. Payers need to first get the basics right, then think through how to use value-driven care models and engage with partners like providers and employers to get closer to members as they think about a more holistic health experience.
  • Reinvent data and analytics. The best customer-service organizations capture real-time data to address customer needs. However, health plans have routinely measured member risk and medical cost on a retrospective basis. By analyzing real-time customer touchpoint data and risk insights, health plans can quickly take action to create much more meaningful customer-relationship management, including care management.
  • Become relevant at the point of care. For value-driven care models to work, both health plans and providers need to align around the customer experience through benefit design and member engagement. Health plans should offer recommendations and facilitate clinical decisions with data and analytics rather than putting up hurdles and requiring permissions. For many health plans, this will require a significant shift in culture and their business model. Value-driven models have aligned financial incentives, but the member experience will fall short unless payers rethink point-of-care member engagement.
  • Be proactive. Health plans must proactively engage with customers at each point of interaction, in much the same way that major web retailers consistently make suggestions to a customer based on previous shopping habits. Technology can help track behavior patterns and identify opportunities for positive, proactive engagement with your customers.

Customer experience has long been neglected in health care, but as competition intensifies and consumers become more discerning, health care organizations will have to adjust. Forward-thinking health plans already recognize the importance of customer experience in value-driven care. It’s time for the rest of the industry to catch up.

Erik Swanson is an executive director in the Advisory Health practice at Ernst & Young. The views expressed here are those of the author and do not necessarily reflect the views of Ernst & Young.

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