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Meet the Dynamic, Uncertain Healthcare Journey Head-On

Healthcare journey is critical for the entire industry as it affects the healthcare service providers, patients, and technology vendors.

An infographic from America’s Health Insurance Plans (AHIP) details the many uncertainties facing payers and providers due to COVID-19 that throw into question how to set premiums for the 2021 individual market. Delayed elective and non-urgent care, losses in employer-provided coverage, and health care costs related to the pandemic are among the many uncertain factors that must be taken into account for setting premiums.

This is just one small slice of the sudden disruption and upheaval to the entire healthcare industry that is affecting payers, providers and the healthcare consumer alike. Contributing to this break from norms is the trend toward healthcare consumerism that recognizes an empowered healthcare consumer as in charge of a dynamic, increasingly digital healthcare journey.

As digital transformation accelerates and consumer behaviors rapidly change, payers and providers are challenged to deliver the consistent, relevant healthcare experience that consumers now expect. This gap between expectations and the reality of the experience are driven by long-standing barriers including entrenched data siloes, unintegrated processes and a confusing matrix of engagement touchpoints.

Amid a healthcare crisis, these challenges may seem untenable. But there is a way through.

By developing a deep understanding of the healthcare consumer, organizations can then use machine learning and advanced analytics to pinpoint the next-best-action – whether a message, care gap action, treatment option, provider referral or any other –personalized to an individual consumer. This empowers healthcare organizations to close the gap and deliver personalized engagement throughout a dynamic journey, across any digital or physical touchpoint.

Guiding the healthcare consumer through new, dynamic situations requires data. A single view of the healthcare consumer that includes all clinical and claims data combined with behavioral, demographic and preference data makes new delivery models possible. Payers and providers are able to form new partnerships that effectively break down the traditional data siloes and overcome disjointed consumer journeys.

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The single view of the consumer is the key to unlocking personalization because it tells a payer or provider everything there is to know about the consumer, and it is updated in real-time to ensure that every interaction is perfectly in sync with the consumer’s journey. This golden record is the fuel for machine learning and advanced analytics that empowers healthcare organizations to engage with individuals – not broad populations – to best communicate in the right channel, optimize engagement, and become a more trusted provider.

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The combination of data and machine learning are the critical elements required to personalize engagement at scale, effectively walking hand-in-hand with the consumer throughout a dynamic journey.

While some AI payoffs are far into the future, this technology and its benefits are available now.   One value-based care program uses CDP software to bring relevant data from both the payer and provider side together to improve the effectiveness of personalized engagement.

To drive Medicare Advantage acquisition, the program matched prospects with providers that were the best fit for an individual consumer, including matching specialists treating the prospect’s specific condition, or matching Spanish-speaking consumers with the nearest Spanish-speaking providers.

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Personalization touches included emails with videos, postcards and direct mail that were sent directly from the provider, rather than the usual genericized messaging from a payer.

The program, which resulted in a significant ROI including increases in new consumer acquisitions, was made possible with a single view of the consumer that combined traditionally siloed data. It exemplifies the vast opportunities possible when innovative payer-provider partnerships put the healthcare consumer first, and recognize the power of relevant, personalized experience to produce better outcomes, drive down costs and enhance consumer satisfaction throughout a dynamic, digital healthcare journey.

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