Healthcare’s Customer Awakening

Health plan and provider trends necessitate a customer experience focus.

After decades of stagnation, the world’s largest industry is experiencing unprecedented change. Forbes contributor Reenita Das noted the combined forces of regulatory upheaval and marketplace pressure are driving the need for customer-experience focus within the healthcare industry. Trends impacting healthcare today include the increasing influence of consumerism, the demand for transparency, an influx of new customers and attempts to manage accelerating costs. As patients’ perceptions increasingly influence and shape the emerging healthcare economy, payers and providers must manage expectations and engineer positive experiences to remain competitive.

1) Shift towards consumerism
The focus is shifting for health plans and providers: the end-consumer, increasingly bypassing traditional channels, is becoming the customer. Health plans now interact more frequently with the end-consumer. While in the past they dealt with large commercial accounts and sold through brokers or directly to employers, today health plans are increasingly focused on individual markets, with companies selling directly to consumers or companies selling via exchanges. In the provider community, a focus on patient-centered medicine and wellness is overtaking the traditional model of treating individual cases as they arise. Providers’ responses include a holistic approach to the total care needed by the individual consumer.

“Both the public and private sectors are working hard to discover ways to transform the system by increasing value and becoming more responsive to patients’ needs and preferences,” notes Anne Weiss in the Health Affairs Blog. Providers are using customer-centric services and tools such as creative financing and user-friendly credit. “Change is happening on a number of different fronts,” continues Weiss, “ranging from how insurers design coverage, to how we pay health professionals, to how hospitals are organized.”

“As patients’ perceptions increasingly influence and shape the emerging healthcare economy, payers and providers must manage expectations and engineer positive experiences to remain competitive.”

2) Demand for greater end-consumer transparency
The trend toward consumerism leads directly into the demand for greater transparency as customers become more aware of the choices available across providers, services and cost structures. Arguably behind other industries when it comes to helping their customer make informed choices, healthcare faces unique hurdles regarding information transparency. In addition to a culture traditionally lacking experience in transparency with the end-consumer, health plans and providers often must disseminate complicated materials, contributing to the industry’s reputation for obscurity. Provider billing rates, different insurance reimbursement rates, insurance benefit plan agreements, and other complex rules governing the end financial liability due for a given service or set of services make the transparency initiative particularly challenging. Providers, accustomed to communicating in the language of their field, often use detailed clinical explanations when interacting with their patients. Limited access to cost and quality data also creates hurdles. Initiatives like the OpenNotes project, which attempt to engage patients by allowing real-time access to their doctor’s clinical notes, or the many early attempts to make cost data available online begin to address these issues, but uptake is slow.

3) New customers entering the system
The emergence of government-sponsored exchanges and Medicaid program expansions has opened up coverage to more lives than ever before. The Affordable Care Act increased both the number of those insured and respectively, the number of patients available to engage with the provider community through traditional means. These new customers often need education to facilitate their use of these services.

“Health insurance is one of the most complicated markets for consumers to understand, but insurers can ease the entire experience for its consumers,” explains Dina Overland in industry blog FierceHealthPayer. The fastest growing segment of customers, she notes, “tend to favor companies that offer easy account management, simple payment features, quick access to policy information and site navigation.”

4) Counteracting accelerated cost increases
Efforts to “bend the cost curve,” or address the unsustainable acceleration in the cost-of- care, are complicating insurance products and may materialize in changes in provider/patient interactions. The industry understands that cost trends are unsustainable, and is working collaboratively to correct the problem. The healthcare industry has offered new solutions, piloted new programs and developed other collaborative efforts between health plans and providers to lower the increase in inflation. The added complexity resulting from these collaborative solutions threatens to further confuse the consumer. Any challenge to the consumer’s quest for “decision simplicity“, which Patrick Spenner and Karen Freeman define as “the ease with which consumers can gather trustworthy information about a product and confidently and efficiently weigh their purchase options,” can compromise customer experience.

With so many forces compelling healthcare providers to refocus their customer experience imperatives, it never hurts to seek help from the experts. We’ve identified four impactful trends in the healthcare industry. Now learn how to respond. Visit Baker Tilly to find out how we can help you differentiate through customer experience innovation.