The New Business Model for Healthcare Payers and Providers

Personalize Experiences for your Customers and Patients or Risk Losing Them.

Trends including self-directed healthcare and an increasing expectation for personalization are driving customer experience imperatives across the healthcare industry. "The focus is shifting for health plans and providers," explains my colleague, Baker Tilly principal, Michael J Patti. "The end-consumer, increasingly bypassing traditional channels, is becoming the customer." Companies must reshape their business landscape to manage expectations and deliver powerful personalized experiences to remain competitive.

Self-directed Healthcare
"Patients are increasingly taking an active role in their care experience and are evermore empowered to choose their own care alternatives," notes the Institute for HealthCare Consumerism (IHCC). As payment plans have evolved putting more of the onus on the consumer, patients with an increasing stake in reimbursement are seeking greater control in treatment options.

According to the U.S. News Health Care Index, less than half of private health insurance plans had deductibles in 2002 but that number rose to more than 80 percent by 2013. A Kaiser Family Foundation report shows the average amount a person had to pay out of pocket for medical care after insurance skyrocketed 255 percent from 2006 to 2015. The rising costs motivate the search for personalized healthcare practices.

"In a landscape of increased consumerism, payers and providers that are able to create personalized experiences for their patients will excel while others fall by the wayside."

Trends spanning multiple industries, such as instant digital access to specialized knowledge, also contribute to the customer-centric climate. "People have access to more information than ever before and are using this information to improve their health," explains healthcare entrepreneur Julia Cheek. Frustrated by a customer experience seemingly clogged by regulation and paperwork, she continues, "more patients are turning to personalized healthcare — a term used to describe a model that tailors medical care to individuals and enables patients to pivot healthcare to their specific needs."

Quest for Personalization
In a landscape of increased consumerism, payers and providers that are able to create personalized experiences for their patients will excel while others fall by the wayside. Consumer preference for personalization is quantifiable. The study outlined in "Selecting a provider: what factors influence patients' decision making?," in the Journal of Healthcare Management found reputation of both the physician and the healthcare organization topped the deciding factors in patients' decisions. Word-of- mouth trumps marketing materials. "Few respondents indicated that advertisements or formal sources of quality information affected their decision making," notes the study.

How can organizations respond to these expectations? According to the IHCC, "the key to driving a more consumer-based healthcare experience is to devise a cost-effective method to capture and analyze" personal information. Then harness this info to customize online and in-person interactions. The authors of "Selecting a provider: what factors influence patients' decision making?," recommend healthcare organizations respond to customer decision-making priorities by managing referral sources, providing excellent service, and harnessing new media and social networking to build their reputations.

Accustomed to 24/7 digital access and constant connectivity, patients want to be able to connect instantly with doctors and payers and receive personalized treatments via digital devices. "It is a natural occurrence that people are expecting personalized positive experiences and that the healthcare model has started to adapt," says Cheek, CEO of at-home health testing provider EverlyWell.

"Providers must reevaluate their customer relationships and redefine themselves to remain competitive," asserts Patti. Wondering how to effectively integrate CX innovations into your organization? Contact a Growth Strategies Advisor to get started.

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