Re-engineering the Member Experience: Solutions & Strategies for Consumerism (Part 2 of 3)

By Shobhit Saran - Asst. Vice President, Health Plans & Sidharth Makhijani - Healthcare Consultant

Our previous blog highlighted emerging trends for health plans and the need to reengineer member experience. Part two of the series details solutions & strategies for health plans, focused on creating a consumer-grade member experience. Health plans today should develop strategies on how to leverage the member assets which include data and experience, to help carve out a proactive member-centric strategy. The focus should be to reduce silos, improve care and lower costs, through secured and personalized data access.

Health plans which aim at providing the best member experience need to make significant investments in the below mentioned priority areas:

  • Omnichannel engagement
  • Human centered services design
  • Real-time architecture
  • Member analytics

CitiusTech understanding the importance of the subject had conducted an insightful webinar on how health plans are trying to reinvent member experience with a focus on consumerism. Speakers included veterans from the healthcare industry, Gloria Romeo, SVP of Product & Development at Highmark Health Solutions and Patrick Getzen, former Chief Data & Analytics Officer at BCBS of North Carolina. During this webinar our speakers too endorsed the above-mentioned priority areas for health plans to enhance their member experience.

Omnichannel Engagement

Digitize member touchpoints to have a seamless & unified experience across the health plan ecosystem. Health plans need to revamp their omnichannel engagement strategy to have a member-centric approach. This can be done through modernized portals, SMART mobile applications and platform-driven experiences thereby enabling members to make accurate decisions at any point in time.

During the webinar, Mr. Getzen emphasized on the importance of omnichannel & personalized experiences which help members navigate care easily. He made a distinction between using a channel to engage healthy members, members who need to boost health, and those who need help with chronic care. He points to studies that show how the millennials and generation Z population want different engagement models from older populations. He emphasized that millennials prefer to interact with Chatbots.

Human Centered Services Design

Health plans are now emphasizing on the importance of services design in their member experience strategy. Services design aims to optimize operations workflow and deliver better experiences across the member journey. Health plans need to understand the issues that members face at each of the touchpoints right from purchasing a plan to renewals. Creation of member personas and service design briefs will help analyze these issues and solve the question of enhancing a member’s care journey. Health plans will need to incorporate these changes by developing design blueprints and create proof of concept prototypes which will be an iterative process for continuous improvements.

Real-time Architecture

Health plans need to build their member data architecture which is the most crucial part of a member experience strategy. This data layer serves as the critical foundation for all member analytics and outreach programs. Near real-time data access is a pressing need for health plans for which they need to adopt an event-driven architecture and domain-driven design approach. Creating a robust and resilient real-time data architecture can be achieved by integrating multiple data sources, including claims, clinical and behavioral data, surveys (e.g., CAHPS), third-party sources, as well as census data. These sources enable health plan’s have a longitudinal health record for each member.

Member Analytics

While data is key to deliver consumer-grade member experiences, analytics provide the insights that drive engagement and interventions. Identifying precise cohorts is key to effective chronic condition management. For example, health plans can generate prescriptive care management programs based on disease severity, prioritizing members for improved medication adherence while enhancing campaign efficacy and maximizing their multichannel outreach. This approach not only personalizes the member journey at every touchpoint but leads to member retention as well. Health plans can support members to make informed decisions through AI/ML-powered text and speech analytics, data-driven member recommendations for next-best action, chatbots, and other technology tools.

Talking about member analytics, our speakers discussed how they created tools like cost-share waivers, wellness credits, and digital tool engagement for credits based on member analytics and its value to personalization.

With consumerism being a big focus area for health plans, there are strategic investments being made to build their member experience capabilities. This will help health plans achieve higher margins and significant cost savings in the long run.

Our final blog in this series zeroes in on how health plans can use member analytics to identify high-risk members with complex conditions and execute effective interventions in near-real-time to provide a seamless member experience.

Related to topics:

Explore other blogs

Precision Medicine: Way Forward through Real World Data
Precision Medicine: Way Forward through Real World Data
CitiusTech: Driving digital transformation in Healthcare with AWS HealthLake
CitiusTech: Driving digital transformation in Healthcare with AWS HealthLake
Consent Management for Patient Data Sharing
Consent Management for Patient Data Sharing


No items currently match your filtering criteria.