Healthcare Payer and Provider Trends – What You Can … · Consumerism. These buzzwords signify the weight of advances and challenges that healthcare providers and ... Healthcare

Members purchasing health insurance on the exchanges will be faced with a choice each year, and those choices will be right in front of them for comparison. A poor customer experience this year will increase the likelihood of finding a new payer next year.

Based on 2014–2015 data,

38 percent of members changed their health plans in state exchanges within one year.

Digitization. Engagement. Consumerism.These buzzwords signify the weight of advances and challenges that healthcare providers and payers face every day. At their core is the gradual shift of the healthcare industry toward a care model based on value and the consumerization of the healthcare patient.

Healthcare TrendsOur trends forecast draws from the industry need to optimize the customer or patient/member experience to make brands more competitive. This means reducing monthly costs per member, improving satisfaction and loyalty to payers and providers, and leveraging technologies to increase self-service capability.

Addressing these challenges includes tackling issues such as meeting increasing workforce demands, leveraging data to offer consumers a better experience, and using technology to improve outcomes and lower costs beyond the four walls of a hospital or a physician’s practice.

For PayersThe Primacy of Data Continues UnabatedPayers used to leverage analytics to look for ways to reduce operational costs. This year and beyond, the focus will be on creating highly targeted products, channels, and service offerings that keep patients healthier. For example, payers will use highly personalized behavioral data to make wellness recommendations for members. This targeted approach of wellness is possible with analytics resulting in higher adoption rates compared to a traditional outreach.

Customers’ Leverage Is a Game-ChangerMembers purchasing health insurance on the exchanges will be faced with a choice each year, and those choices will be right in front of them for comparison. A poor customer experience this year will increase the likelihood of finding a new payer next year. Based on 2014–2015 data, 38 percent of members changed their health plans in state exchanges within one year. With price points remaining comparable, customers will continue to look to service and experience as key differentiators when choosing a health plan.

Continued Front-Office/Back-Office IntegrationLowering administrative costs and enhancing efficiencies will be a priority for most health plans this year, as they seek to challenge new competitors, penetrate new markets, and assess strategies for creating an optimized customer experience. Realizing these goals will require health plans to rethink their business models—most notably, bridging the gaps and uncovering integration opportunities between front-office and back-office processes.

Healthcare Payer and Provider Trends – What You Can Expect

Nurse Support IncreasesAs a tactic for improving customer experiences (as well as their health) more health plans will invest in consultative support by highly qualified healthcare professionals, such as nurses. HGS’s 1,500 registered nurses are supported by a health information line and nurse triage, level-of-care assessments, and wellness solutions. These professionals will enhance the customer experience by providing answers to routine customer queries, perform care assessments, and offer healthcare advice and information.

For ProvidersEngagement and Activation Become More SeamlessTechnologies that enhance and improve patient engagement and activation will be critical to healthcare moving forward. Through population health management, we are learning more about how to create wellness strategies and to stratify patient populations based on their conditions and adjust for nuances in age, race, diagnostic groups, and the like.

A critical aspect of engaging patients is delivering a unified, seamless experience across the channels or devices of their choice, be it via smartphone, laptop, landline, email, or online chat. This is a very different experience than many members have had with providers in the past, but it represents the level of convenience and service consumers have come to expect in markets ruled by the consumer experience across the economy.

Telehealth GrowsThree elements are required for telehealth to become part of the mainstream of healthcare:

• It needs to hold healthcare costs down.• Providers must be reimbursed for the time spent on

telehealth.• Patients must be comfortable with a remote visit

instead of an in-person visit.The first and second requirements are being taken care of by the Centers for Medicare and Medicaid Services (CMS) and its use of a code that pays providers to deliver remote care management services to patients with two or more chronic conditions. The goal is to help those patients get better and stay well.

As for the third requirement, teleconferencing applications are making consumers comfortable communicating electronically. The ability to visit a physician via a smartphone, tablet, kiosk, or other technology creates convenience. For many, 10 minutes via video conference versus long waits in waiting rooms for a 10-minute visit will become the preferred method of interaction for many simple healthcare encounters.

While not all of these predictions are particularly revolutionary, they do point to an industry that has ably faced the winds of change and is eagerly seeking to build on recent successes.

About HGSHGS is a leader in optimizing the customer experience and helping our clients to become more competitive. HGS provides a full suite of business process management services from marketing and digital enablement services, consumer interaction services to platform enabling back office business services. By applying analytics and interaction transformation design to deliver innovation and thought leadership, HGS increases revenue, improves operating efficiency and helps to retain valuable customers. HGS expertise spans the telecommunications and media, healthcare, insurance, banking, consumer electronics and technology, retail, consumer packaged goods industries, as well as the public sector. HGS operates on a global landscape with around 40,000 employees in 65 worldwide locations delivering localized solutions. HGS, part of the multi-billion dollar Hinduja Group, has over four decades of experience working with some of the world’s most recognized brands.

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HGS’s 1,500 registered nurses are supported by a health information line and nurse triage, level-of-care assessments, and wellness solutions.