Healthcare’s Next Frontier: Building a Fully Connected Experience
The long, slow road of healthcare transformation is now an expressway. Health plans that are ready to seize the opportunity to create an interconnected consumer-centric experience will lead the way.
Let’s start with a troubling statistic. Only 33 percent of consumers trust their health insurance organizations. In contrast, consumer trust in hospitals and physicians is much higher at 72 percent and 60 percent respectively.
The reasons for this lack of trust in health plans are many, but at the top of the list is poor customer service. In fact, more than half of consumers say their experience with their health plan (as opposed to things like benefits and network access) was a key factor in deciding to switch insurers.
When dealing with health plans (and the healthcare system writ large), members and patients must still endure a fragmented and frustrating experience – one that lags far behind other market sectors that offer a much more consumer-focused experience. If health plans want to foster greater trust with their members, they need to dramatically improve the member experience.
But how?
Here’s the good news
Thanks to a host of new and innovative consumer-engaging technologies, such as generative AI (GenAI), the opportunity for health plans to radically transform the member experience has never been more available. Consider the possibilities.
- What if health plans today could serve as the digital front door for their members’ entire healthcare experience?
- What if health plans delivered a unified digital experience where members can consult with their entire care team in a single thread of conversation, contact customer service about their benefits, schedule an appointment, track their steps, improve their wellbeing, and more — all in one digital setting?
Not long ago, these questions were merely hypotheticals. Today, these possibilities are being realized by forward-thinking health plans who understand the business necessity of transforming the member experience.
By offering a consumer-centric healthcare experience to its members, health plans can improve member satisfaction and retention, lower costs, improve outcomes, and serve as a key differentiator in an increasingly competitive market. Indeed, one study found that the adoption of digitally enabled capabilities could reduce medical cost by as much as $175 billion to $220 billion annually. Here are just three of the cost–saving capabilities that a consumer-centric, fully connected healthcare experience delivers.
1) Improve longitudinal care: More than $4 trillion — an astounding 90% of total healthcare expenditures in the United States — is spent each year to treat individuals with chronic and mental health conditions. Cost-effective management of these conditions requires that members become active and ongoing participants in their own healthcare. Research also shows that people with both mental health and chronic care conditions benefit from care coordination through improved health outcomes, reduced healthcare costs, better medication adherence, and increased self-management. A fully connected, end-to-end healthcare experience transforms care from a series of disconnected and episodic transactions to a longitudinal relationship between the consumer and the healthcare system. It provides much greater access to immediate care with one-click access to a nurse whenever health concern or troubling symptom arises. It guides, informs, and motivates members in real time to engage in the next best step to better health. Members experiencing high stress levels, for example, could receive personalized reminders and timely nudges to engage in mindfulness exercises or breathing exercises, earning rewards as they track their progress. They might also get contacted by a personal health coach or nurse to see if they would be interested in scheduling an appointment with an available behavioral therapist.
2) Deliver on-demand access to primary care: Almost a third of all Americans do not have a primary care provider (PCP). That’s more than 100 million people who lack the resources to prevent or manage chronic conditions and to identify risk factors that could lead to serious conditions. This is a “medically disenfranchised” population that often does not seek medical attention when a medical issue arises. And when they do, it’s often the ER. But today, there are now digital health solutions that can select the right PCP for each member and then coordinate a telemedicine or in-person appointment. Providing 24/7 access to an on-demand care team to anyone who has a mobile phone or internet access creates a “direct line” to primary care that overcomes transportation barriers, long wait times (26 days for a new patient), scheduling issues and other obstacles to care. It takes almost no effort now for members to seek care and start building a relationship with a provider.
3) Make it personal: Advanced data collection and analysis capabilities and the sophistication of AI chatbots by GenAI are creating a new level of personalization that precisely matches content, incentives, and motivation to each member’s wellbeing goals, preferences, and needs. Higher personalization generates higher engagement, which decreases the cost of care. Personalized proactive care engagement, such as push notifications and real-time alerts for post-visit summaries, aftercare follow-ups, and upcoming appointments keep members informed and engaged. In doing so, support comes to the member, instead of the member having to seek out support.
Two simple questions
It comes down to two simple questions that every health plan should consider: “Are we a company that pays for services and manages risks? Or are we a company that delivers better health for our members?” The business case for answering that second question in the affirmative is highly compelling. It’s time for health plans to seize the moment and leverage the transformative digital technologies that are already revolutionizing the health plan member experience.
Photo: Feodora Chiosea, Getty Images
Rita Sharma is the Chief Product Officer at Pager Health, a connected health platform that enables healthcare enterprises to deliver high-engagement, intelligent health experiences for their patients, members, and teams through integrated technology, AI, and concierge services. At Pager Health, she is responsible for leading the product team and the creation, innovation and execution of product strategies and roadmaps. Rita also leads the development of go-to-market strategies and solutions in engagement, care navigation, virtual care, wellbeing and value-based care on a global scale.
Rita comes to Pager Health from Salesforce, where she directed the global development and release of the company’s first healthcare product, Health Cloud, focused on transforming patient and member-centric experiences in healthcare and life sciences. She was responsible for Health Cloud’s long-term product roadmap and global go-to-market (GTM) strategy and positioned Salesforce as the platform of choice for provider, payer, pharma, and device segments globally.
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