Experience + Job = Relationship
Let’s translate the concept to health care and engagement. Payers sell benefit plans that have become commodities. The payers “do the job” of providing benefits plans and services although the experience of purchasing and using them is less than desirable. Forrester publishes an annual customer experience index and health plans land in the poor to very poor range. There is no differentiation and a low barrier to change payers … and no relationship. Payers want to engage consumers and help them live a healthy life but consumers cannot be engaged at this stage; consumers need a relationship to become engaged. A relationship can be developed and nurtured once the experience and job to be done is high. At this stage, consumers are satisfied and open to a relationship with the potential to be engaged as the relationship develops. It makes sense to enhance the experience.

Let’s look at how payers process claims. We may be able to say they process claims efficiently, so the job gets done but how does it impact the experience with a member? A payer may say there is no member experience in this process; we just process the claims internally. They are right and wrong. They are right in that payers do not generate a member experience in this process? In lieu of a crafted experience, the member will start wondering what happened to my claim. Instead of thinking the process is going well, they may think the worst; we always do. So after a period of time, the member calls the payer to find out what is going on and the member is already at a frustrated stage. The call cost the payer three to five dollars. If we generate a member experience around the process, we can stop frustrating the member and not incur the cost of a call. What if payers provided a communication using a SMS or email message to advise members where their claim is in the process? Sound familiar? I love to see my tracking information from my Amazon orders to see how the order is progressing. Seeing activity or progress satisfies me in my wait for claims processing and results in a good experience for me. If payers communicated where a claim was as it traveled through the process, the member experience increases. They would know since the payer took the action first and generated a dialog around the claim event. This may sound like a reassuring voice such as, “Don’t worry, we are providing personalize attention to your claim.” Members would get to choose how much information they want and select their channel preference. It’s all about “me” in the world of the consumer. This is just one example of designing a good experience. With a positive experience and products that do the job; payers can build relationships with members through communications and interactions. This is the area that engagement is spawned.

To build relationships, payers should have to focus on the following:

• Offer a product that does the job for consumers.
• Provide a grand experience in two areas. A well designed user experience on all user touch points and also a tuned customer experience so that consumers are happy about interacting with the payer during their journey.
• Extend their products to be more than benefit plans and also provide their members tools to help them in their pursuit of healthy living and enjoyable lifestyles. Do this and the “doing the job” indicator goes up in scale.

Building relationships aids in member engagement and increases retention. It is about the quality of the interaction and not quantity. The relationship is formed around common goals such as improving members health. If the interaction is pointless and without value, it becomes annoying to the member and the experience deteriorates.

Engagement is Good
Engagement, at a member level, has many benefits for, not only members, but for payers and the health system. At the engaged stage, payers can:

• Modify member behaviors to lower causes of chronic diseases
• Promote healthy living behaviors for members
• Offer information and tools to help members make intelligent health decisions

Medical costs are increasing at an alarming rate each year so member health is a priority for payers and providers. The CDC says chronic diseases account for $3 of every $4 spent on healthcare and chronic diseases are preventable by modifying consumer behaviors. This is a perfect example of how consumer engagement solutions can help lower costs and decrease chronic diseases but a relationship must be built for this work. For payers to engage their members, they need to focus on two things: (1) the customer and user experience and (2) a product or service that performs what the member wants to do.

Consumer Centricity
Consumer centricity needs to be raised in priority just as cost management is a focus point for payers. Engaging members in healthy living and using self-service tools is important in lowering health costs and empowers the members in an era of consumer driven health care. So in the end, a sustainable solution to lowering health costs and having a healthy member base over the long term can be through consumer centricity. This approach takes time and is an investment in the health system and in its members.

If you are looking for low hanging fruit, focus on the customer experience. The fastest road to a good experience is remove pain points in services and products that touch customers … usability testing can provide shocking results. You can turn an annoyed customer into a satisfied customer by assessing online assets using a user experience discipline and updating the design based on the findings.

Some ideas are to offer consumer centered products and services aligned to personalized needs, tune customer experiences to build relationships, and engage members in healthy living and decision making with personalized programs. These are examples that can contribute to lower costs by improving member health and consumer engagement. Payers now have a raison d’etre and they remain relevant. Payer can use their big data repositories to help their members by delivering useful information and tools backed by a terrific experience. Why would it work? They took time to build relationships and trust with their members and shifted into a consumer mode of business. Moving to a consumer view is a graceful slide toward diversification since payers can provide solutions that accommodate members when they live the most; in their lifestyle.

How does this resonate with your experience at your payer? As a consumer, what are your expectations of your payer?