say ahhhh
The all-powerful consumer becomes surprisingly tame when dealing with the healthcare system. PHOTO: Juhan Sonin

Customers have never held more power or had more choices. We demand service when we want it, where we want it and how we want it — and organizations scramble to keep up with our demands.

And yet ... 

The all-powerful consumer becomes surprisingly tame when dealing with the healthcare system.

Somehow the laws of customer experience become null and void when dealing with healthcare organizations, physicians or insurance payers. 

This is going to change. 

Healthcare Faces a Perfect Storm

The healthcare industry is about to experience the same shift we saw in retail, banking and hospitality. 

The healthcare system is on the verge of a perfect storm. A silver tsunami — in the form of the aging baby boomer population — is going to hit very soon, putting the system through a stress test, while pressures from millennials and Generation Z will force healthcare organizations to choose newer forms of engagement. 

Increasing pressure from payers and regulatory agencies will demand newer care models like “pay for performance” with a focus on overall wellness rather than the disease. 

To meet such diverse needs, healthcare organizations will have to look for newer avenues for operational excellence. So what changes can we expect in the near future?

Improved Patient Understanding and Personalized Care

Healthcare organizations scatter member or patient data across many systems. 

Modern data management technology is helping some organizations gain a complete understanding of their patients and provide them with personalized care. Information about health records, physicians, caregivers, claims and reimbursements are all consolidated and merged to create a complete view of the patient. If a patient leaves the practice and joins back after a few years, healthcare systems can reconnect the past records to the new enrollment. 

A single source of truth for member information helps deliver consistent care and information across all channels, including personal visits, call centers inquiries or claims adjudication. All functional groups have the latest and correct patient information. A single source of reliable data also allows for quick enablement of new interaction channels. Many providers are offering video chats with physicians that provide flexibility, immediate access and reduced costs.

Soon members of healthcare organizations will be able to access products and services when they want, where they want, using the channel of their choice.

Understanding patient preferences and accurate segmentation will allow the organizations to create specific programs for a particular demographic and offer members the information tailored to their individual needs. With correct segmentation, healthcare providers can organize wellness camps and training classes with much better response rates. 

Improved Collaboration Across Payers, Providers and Pharma

As patients get more involved in their care, they force the payers, pharma and providers to come together and provide a holistic approach towards overall wellness. When these entities work together, they can develop much more efficient treatment programs with better results. 

To work together often means sharing data in a secure manner. There's been a resultant push across these organizations to promote a data as a service plan, where they can safely exchange patient information to develop and deliver better therapies and monitor the effectiveness of treatments. 

Collaboration like this is a step towards personalized care and medicine. If these organizations are not connected, personalized healthcare will remain a dream. Such connected healthcare requires the availability of reliable data with all affiliation information shared securely.

Understanding the Network of Relationships

Understanding affiliations and relationships is a very critical aspect of information in the healthcare system. It’s not just patient data that’s required to deliver the right care. Organizations need to know the complex many-to-many relationships between patients, family members, doctors, caregivers, health care organizations (HCO), locations, payers, plans, products, pharmacies and prescriptions. 

In the absence of this information, no picture is complete — neither the patient’s, nor the physician’s, nor the HCO’s or payer’s. Once the affiliation information is available, healthcare organizations can make better decisions about a patient’s care and design the treatment options that work best for them.

Relevant Insights for Better Health Outcomes

Having built the reliable data foundation that not only includes the patient, physician and payer data but also the relationship between all entities, this information can be leveraged to design treatment plans for better health outcomes. The focus shifts from “fee for service” to “pay for performance.” 

Customers and group clients (corporate customers of healthcare plans) are demanding not just cures for ailments, but wellness and health management programs. Moreover, regulatory agencies like CMS (Center for Medicare and Medicaid Services) are evaluating healthcare organizations for the service experience. 

In this situation, getting relevant and timely insights from the information, in the context of the business function, becomes critical. Predictive analytics and machine learning technologies are helping organizations garner the relevant insights to improve treatment adherence, reduce readmissions and run more impactful preventive and wellness programs. 

Relevant insights can also help determine the segment of aging patients who are nearing the transition from commercial health plan to Medicare programs. Providing such patients with pertinent and timely information to smooth the transition improves the service quality as well as membership numbers. 

Get Ready for a Patient-Centric Future

We’re not that far away from the rise of the patient. Patients today expect the same experience as they get from a retailer or a bank. They want to be more involved in their care. They expect all relevant parties like providers, payers and pharma to collaborate and recommend the best treatment options. 

Changing business models, customer expectations and newer regulations will accelerate the evolution of healthcare. The transition will not be easy, but building a reliable data foundation is the first step towards a patient-centric healthcare system.