Transforming member experiences and outcomes with personalized services

Team Innovaccer
Fri 18 Jun 2021
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Consumerism is steadily gaining momentum in the healthcare space. Payers are under constant pressure to improve member experiences and health outcomes by implementing patient-centric business models. However, there is no one way to cater to the entire member population. Member needs can be quite diverse. On one hand, the U.S. population is aging, and it’s estimated that by 2040 there will be 80 million people above the age of 65. Payers need to keep conventional channels of communication open. On the other hand, Deloitte’s 2020 Survey of U.S. Health Care Consumers revealed that 42% of Medicare Advantage (MA) plan enrollees used technology for health improvements, and those who enroll over the next 10 years will be even more likely to do so. This indicates that health plans will need to build on their digital capabilities. In particular, payers must undergo a digital transformation to accommodate the differing needs of the population and offer personalized services.


Personalizing member experience is vastly different from serving a broad population. Members from various backgrounds come with different communication preferences. Payers need to transform their internal processes to provide superior member experiences by:

  1. Consolidating member data

To customize services, payers need a streamlined database of member health information. However, data points in their systems change daily. Payers are associated with hospital systems and practice groups that employ multiple clinicians who keep adding and altering clinical information. This information is imperative to treating patients and managing provider reimbursements, but its dynamic nature makes it challenging for payers to manage. Payers need to replace legacy IT systems with modern data management systems that unify claims and clinical data in real time. Combining data from multiple sources to generate a single member view can enable payers to identify healthcare patterns and understand how to improve care for members.

  1. Scaling personalization efforts

Since the 2000s, MA health plan enrollments have steadily increased. Four out of ten Medicare beneficiaries chose to enroll in an MA plan in 2020. Payers need to ramp up their personalization efforts and ensure that their initiatives are scalable. Applying a layer of analytics on dynamic member health databases and driving real-time actions is challenging in itself but doing it for a large member population is a major feat. Payers need a complete system overhaul to deploy their solutions at scale, which may disrupt their regular workflow. However, this is a tradeoff that will prepare them for future opportunities.

  1. Preparing to meet growing member preferences

Healthcare personalization entails creating multiple touch points for members. They should be able to pick and choose their mode of communication according to preference. Health plans need to expand their operations to accommodate their members’ preferences, gauge their decisions in real time, and fulfill them. The healthcare journey is no longer a linear path and payers must prepare to meet new needs, especially around digital communications. A survey revealed that 77% of consumers would prefer to pay their health insurance bills through an online portal. 

  1. Building a harmonious IT framework

Most payers have long been operating on a disjointed combination of homegrown and legacy IT. Synchronizing systems through short-term iterations has been expensive. Between 2012 and 2018, more than $18 billion has been spent on healthcare technology solutions. Payers need to implement a unified solution and build an infrastructure that is flexible, scalable, and capable of embracing technologies in the future. Patchwork solutions are unsustainable, create technological challenges, and affect members’ experiences with payer interfaces.

The road ahead

Transforming the system to engage members can positively impact payers’ long-term financial growth. When member experiences are customized according to their preferences, they tend to be more satisfied and loyal. 41% of healthcare marketers are set to improve patient experience due to increased conversation intelligence. A study by BCG claimed that the 15% of companies in three sectors—retail, healthcare, and financial services—that get personalization right will earn about $800 billion over the next five years. The data proves it: Improving member experience directly translates to improved revenues.


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Tags: Payers
Team Innovaccer
Transforming member experiences and outcomes with personalized services

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