Health plans have eight ingredients to get right

Consumers today expect a lot from the products they receive across industries. Healthcare is not immune. Payers must satisfy the escalating expectations of digital consumers, but they also must make complex connections among the insurer, the employer, employees/dependents and medical providers. When these connections work, they create a cycle of patient engagement, cost-efficiency and value.

But therein lies the rub. Products created years ago are not equipped to make these connections. Health and wellness products are a great example. While they are meant to help people lead healthy lives, these products are linear, complex, reactive, built from the outside in and they are cost (not consumer) oriented. Perhaps it’s no surprise that an Accenture survey of employee utilization of health and wellness product features showed only 29 percent usage.

Quick triage will not fix what’s broken about these products. Payers need to get to the heart of the matter by working with other stakeholders to create a flexible architecture that makes the connections that will drive usage.

Incumbent health insurers have an advantage—they can use the vast data they have about members to create a usage-based product architecture designed to deliver on employer cost management needs and employee engagement expectations, while also closing gaps in information and service capabilities. Unfortunately, they aren’t currently connecting the dots between member interactions and the effects on utilization.

Payers that pursue a new architecture should factor in:

  • Outcomes – The spectrum of goals and results employers expect from the product, consumer motivations, what they value from it and desired incentives.

  • Governance – How decisions are made and who has authority, and what responsibilities are required to design, build operate and evolve the product.

  • Security – Capabilities associated with ensuring the integrity of access, information and transactions in the system.

  • Analytics – Information and algorithms involved in delivering product services and interactions.

  • Experiences – Paths, pain points and values associated with the product.

  • Channels – Matched to the way consumers engage the product and meet increasingly retail-based expectations.

  • People – An organization designed around the expectation of the consumer, with aligned roles, skills, behaviors and rewards.

  • Technology –The right software, hardware, services and facilities that will deliver product value.

A successful architecture will connect the dots between provider, insurer, employer and employee. It enables consumers to choose the products and configurations they want, rather than having a preconfigured plan pushed to them. Payers can use information from the platform to engage earlier and in meaningful ways, based on consumer preferences. In the end, more consumers will use the products, which is a win for payers, providers, consumers and employers alike.

Loren McCaghy

Director – Consulting, Health, Consumer Engagement and Product Insight

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