Health insurers are digitizing their operations by taking notes from, say, people who shop at Warby Parker.
But while member claims can provide a window into a patient's health, personalizing coverage and healthcare is not as simple as picking up a pair of spectacles. A recent Deloitte survey of 35 technology leaders at health plans with 50,000 members or more highlighted this challenge, with 49% of respondents saying a lack of clear vision around how to best engage patients and providers presents the biggest blind spot in their digital transformation.
"As organizations have been going along that journey of how do they modernize their core, the demand in the marketplace, the shift to be more consumer-oriented and engage consumers has really accelerated," said Bill Preston, a principal at Deloitte and author of the study. "Health plans are in this dilemma where they're trying to complete these modernization efforts but, at the same time, they're trying to be responsive to the emerging needs of the customer, which COVID has only accelerated."
Health insurers caught in the middle of long-haul digitization efforts are often distracted by short-term demands from patients and providers, Preston said. Shifting priorities can often stall digital transformation efforts, threatening the care of their members and market share, particularly as companies like Amazon, Google and Apple enter the healthcare space.
As consumers change their preferences around how they engage with their health insurer, and the responsibilities of health insurers shift, it is critical that plans be proactive—rather than reactive—to changes in the digital marketplace, said Terry Rowinski, president of Health Payment Systems, a provider of insurance for self-funded systems.
"As we see the evolution of consumer-direct companies in the market, it's going to start to become a little bit more of a feeding frenzy for employers and consumers, in terms of where do they actually hang their hat to get insurance?" Rowinski said.
Anthem started its digital transformation journey with the hire of CEO Gail Boudreaux about three years ago, and now views itself as a digital health company rather than health insurer responsible for the care of 43.5 million members. One of the biggest challenges to digitizing its services has been responding to the experience needs, and integrating the systems, across the fragmented healthcare ecosystem, said Chief Digital Officer Rajeev Ronanki.
The insurer has used a portfolio-based approach to align the disparate needs of companies, government customers, health systems and individual patients, he said. By outlining the tech features it expects to deliver in the short-term and long-term, and assigning the responsibility of designing and developing those tools to small teams of cross-functional talent, those "breadcrumbs start to come together to build a whole," Ronanki said.
The portfolio approach has helped the Indianapolis-based approach build, for example, an online scheduling system for patients that integrates with "hundreds" of providers' systems, and syncs with their billing processes so consumers immediately understand exactly how much is due when they leave the office, Ronanki said.
"From a consumer standpoint, they don't care if the system is fragmented," he added. "They just want the system to work, so making an appointment with a doctor is like booking a table at a restaurant, and settling your bill at the time that the services performed, rather than getting five different documents from your plan and your doctor and anyone else involved in providing that service."
More members can mean more problems prioritizing digital features, said Nate Foco, vice president of marketing and customer experience at Priority Health. The Grand Rapids, Mich.-based insurer started its digital transformation journey two years ago, recognizing that new competitors in the marketplace represented a threat to the not-for-profit insurer.
"Consumers are used to working in digital experiences in many other different industries, like Amazon, etc., so we needed to be in that same space," Foco said. "In a way, we're not just competing with other health plans for their digital attention, we're competing against everyone."
To articulate its strategy, Priority Health looked at customer survey responses, phone calls and responses to understand its 1.2 million members' pain points when using their benefits. The company also partnered its marketing and IT teams to crunch data on customer needs and build tools to scale its services.
After realizing that many consumers had trouble understanding drug pricing, Priority Health's design and IT teams sat down with its marketing reps to think through how tech could help members better understand their benefits, crunch customer demand data and talk through what systems needed to integrated across its provider partners. Now, when members sign in to their benefits portal, they can type in the first few letters of a medication and Priority's search engine immediately auto-populates different medications. Once consumers click on the drug of their choice, the system automatically crunches individual member claim data to identify their particular drug formulary and cost. Foco said that feature was set to go live for members at the beginning of June.
"We continue to encounter challenges," Foco said. "You're in it for the long haul when it comes to digital experiences. The complexities of our industry are very true and very real. But if you're in tune with what your customers and your members need, and what their pain points are, you can head it off."