What Got Us Here Won’t Get Us There: A Changing Market Requires New Thinking

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The role of today’s healthcare consumer is shifting. Instead of health insurers being in control by simply offering insurance with defined coverage, the consumer is moving into the driver’s seat . . . taking charge of how and where they purchase personalized health plans, managing their care choices and selecting providers as well as monitoring their own wellness and health outcomes. This model completely disrupts the very nature of the health insurance value chain.

Several people around a meeting table look at information on a Dell tablet and laptop

Yet this challenge can be a good thing. Disruption is all about accelerating to the future. It’s all about being bold, rethinking your market focus, redefining the value you bring to customers and reorganizing to serve an increasing business-to-consumer market.   

Accelerating innovation through services

One of a health plan’s best tools to leap-frog from traditional business-to-business models to business-to-consumer models or even extending it to a futuristic consumer-to-consumer model is taking advantage of new IT services and solutions that can make your transition smooth and seamless.

What can health plans expect?

Smart data-driven business insights – Advanced analytics can help drive identifying the right target market, delivering the right services to right customers at the right time. For example, powerful analytics using big data mining, machine learning or artificial intelligence technology and coupled with geo-spatial mapping can create customer micro-segmentations. With a 360-degree analysis of members data (social, economic, clinical, demographic, pharmacy, etc.), you can predict their preferences, health status, care utilization levels and patterns, and inclination to purchase specific products and services. Such meaningful views of consumers provide insights to carve out personalized life stage-based health insurance products tailored to match their evolving health and financial needs.

New ways of delivering health plans – Radically redefining the business as usual in a way that speaks to its members in their own language makes it easy for them to get engaged and do more business – like building the next “Amazon” in a retailed health plan industry. For example, here’s what an Amazon-like retailed health plan might enable you to provide:

  • A rewarding digital shopping experience
  • Real-time underwriting, policy, coverage determination and claims adjudication
  • Automated billing and payments
  • Increased transparency in care cost determination
  • Health expense trackers to manage cost and claims payments
  • Around-the-clock customer services
  • Telehealth-enabled provider consultation
  • Rich mobile experience
  • Incentivized healthy behavior and enhanced social collaboration  

Standardizing processes to reduce administrative cost – An environment where front and back office competencies can be transitioned to a safe digital health and user experience. For example, initiating customer-focused service through social media platforms that reduce call center volumes or implementing digital payment solutions.

Cloud and interoperability solutions – Developing a secured and connected network with provider partners, health information exchanges (HIE) for seamless information sharing between members and the care delivery channels. Payers can leverage HIE clinical data for more robust disease profiling, member risk stratification and help define a targeted care plan integrating firmographic cues that will reinforce tailored medical management and improves outcomes.

Secured patient and member engagement – Revamping presence with capabilities like wellness rewards platform, fitness and nutrition tracking, personalized health reminders, medical adherence monitoring and grocery guides for better health that provide more value and deepen the member engagement with increased trust.

Here at Dell, forward thinking is in our DNA. From our founding in an Austin dorm room to our latest work with personalized medicine and genomics, we are excited about how next generation strategies and digital transformation of processes and relationships are creating new opportunities to reach new markets, retain and recapture members, and grow business in a consumer-centric way.

Dell Services is at the forefront in helping health plans embark on their consumerism journey. From June 3-5, we’ll be at the America’s Health Insurance Plans convention in Nashville. We invite you to come by our booth (#827). Let us help you rethink your health plan strategy and organizational structure so you can discover how to integrate these new models into your organization.

For more information, visit dell.com/healthplans or contact [email protected].

See also Is Your Health Insurer Organization Future-Ready?

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One thought on “What Got Us Here Won’t Get Us There: A Changing Market Requires New Thinking

  1. Great Blog post on what the future holds for health care consumers.  I would add the following perspective that in order for consumers to "drive" the experience and servcies they get, we all need to get a lot more educated on how the indsutry works, and what we can do to impact it.  For far too long, consumers have been held captive by the plans and services their employers offer.  The majority of the cost benchmarks in the industry have been negotiated by the insurance plans with no input from consumers.  The health plans need to get out of the middle, and let consumers decide what to pay for the daily block and tackle healthcare services.

    The perspective I offer is to compare how we use car insurance and services focused on the "health of our automobiles" with healthcare.  For prices on services to come down, the consumers have to be engaged and abile to drive costs down.  What would tires, gas or wiper blades cost if you had to run them through your car insurance company for payment and approval? Car insurance is for when you have an "unexpected" and expensive event like an accident.  Homeowners insurance is for when you have expensive, unexpected damage to your home, health insurance should be the same.  I want to go to the provider with the lowest prices and best service, not the one my health plan tells me I have to see fo the price THEY negotiated.  

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