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Unlock Lifetime Member Value Through Personalized Health Plan Experiences

By Enam Noor, Founder and Chief Executive Officer, Insightin Health published in Healthcare Business Today


In today’s data-driven world, people expect highly personalized consumer experiences. Companies like Amazon, eBay, Facebook, and Apple understand that data is an asset and not a byproduct. They collect and analyze data on individual customer search and buying habits to serve up personalized product recommendations, offers, and discounts to entice action. These companies provide interaction options that put the customer in control. Consumers decide when and how to engage with these retailers – whether that’s via online search, mobile apps, or voice-activated assistant technology such as Alexa or Siri.

Apple founder Steve Jobs had some great advice, “Get closer than ever to your customers. So close that you tell them what they need long before they realize it themselves.” Retailers have raised the bar on consumer expectations and today, nearly every industry is focused on offering their customers choice, flexibility, and speed. Healthcare companies must do the same. It’s no longer acceptable for a healthcare organization to take weeks to get a provider referral or months to close a medical claim. Improving customer experience has been a health plan objective for years now, but progress has been fragmented and slow. Efforts to enhance member experience often fall short because health plans frequently take a generalized, one-size-fits-all approach to addressing key issues. Offering a blanket $25 gift card incentive for an A1-C screening will have little impact on a diabetic that is agoraphobic or lacks transportation to the doctor’s office.

The time has come for the healthcare industry to look at customer experience with more urgency. A series of drivers are currently converging that will make member experiences a crucial factor in determining the long-term success of health plans.

Why member experience and satisfaction cannot wait

Until recently, the healthcare industry was held to a different standard when it came to digital transformation. While sectors such as retail, finance, and hospitality thrived by adopting data-driven, digital-first approaches to consumer engagement, healthcare was still predominantly manual, paper-based, and highly transactional.

Then the COVID-19 pandemic hit. Healthcare providers were forced to offer alternate pathways to care to control patient flow and prevent the spread of infection. This sparked a rapid rise in the use of telehealth and digital communication technologies. Consumers were suddenly asked to take a digital-first approach to interacting with their healthcare providers and plans, and their expectations changed as a result. People now demand the same consumer-driven experiences from their health plans that are commonplace in other service industries.

The analyst community predicted this sea change. For years, healthcare industry analysts have been encouraging payers to deliver consumer-centric experiences and adopt retail concepts to measure their performance.  Plans have been encouraged to create lifetime member value, develop target per member acquisition and retention costs, and deliver personalized next best actions.  Successfully delivering on this front is expected to be a competitive differentiator for Medicare Advantage plans where members are making individual decisions in an increasingly competitive marketplace

CMS (Centers for Medicare & Medicaid Services) also recognizes the value of personalized, consumer-centric healthcare experiences. The organization recently changed the way it calculates payer Star Ratings, placing more weight on satisfaction and experience measures. Member satisfaction and experience now accounts for 43% of the overall Star Rating and will account for 57% of the rating in 2023.

Beyond these market drivers, delivering a highly satisfying, consumer-centric experience is a primary way for health plans to establish a distinct competitive advantage in an increasingly crowded marketplace.

Connecting data to improve member lifetime value

The importance of driving consumerism in healthcare is evident, but many health plans may be unclear on where to start this process. The overall effort may be easier than you think. While healthcare has been challenged when it comes to digital transformation, it does have one significant advantage over other industries – historical data. Healthcare payers have been collecting data on their members for decades. The problem is this data is siloed – stored in multiple, disparate systems, both internal and external to the plan (e.g., claims, pharmacy, care management, medical records systems, etc.)

The first step to providing a personalized experience is to connect this disparate data into one centralized ecosystem. This process should be integrative rather than disruptive. Health plans should seek out a technology partner that can connect data from all sources (e.g., internal systems; partner, provider, and vendor systems; member reported data, etc.) and drive insights to support and enhance existing workflows. Creating a connected data ecosystem positions health plans to make data-driven decisions for personalized member engagement in real-time.

Once data has been connected, artificial intelligence (AI) and machine learning technologies can be more effectively applied to identify patterns and generate actionable insights that enable health plans to generate personalized Next Best Actions (NBA) to drive member behavior.  NBAs can be designed to support individual plan objectives such as closing care gaps, addressing social determinants of health barriers, ensuring care management compliance, improving overall satisfaction, and more. Once individual NBAs are identified, member engagement and outreach can be easily executed by automating workflows or pushing the action into existing care management, partner or provider systems. Improving visibility across data sources enables health plans to be more proactive and personalized in their member interventions and incentives. This not only improves results, but also creates a more satisfying experience that enhances lifetime member value and reduces costs for the health plan.

Leading health plans are realizing the transformative impact of this approach to optimizing member experience. For example, one payer successfully integrated data sets from over 20 different internal and external systems to personalize NBA recommendations to drive Healthcare Effectiveness and Information Data Set (HEDIS®) gap closure. This ability to leverage data for personalized member engagement helps the plan consistently achieve a 4-star rating or higher across its MA contracts, improve retention rates, and attract new members.

This same payer is now leveraging its data ecosystem to improve Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores. It is analyzing data to understand root causes that can lead to lower scores, proactively identify and predict potential exposure, and define NBAs to address workflow issues (e.g. pre-authorization delays, lengthy wait times, etc.) that might lead to a negative provider experience. Engaging with members in a personalized and data-informed manner can help payers address these hurdles before they manifest in negative survey responses.

Data drives insight and insight drives action. These are the building blocks for creating a health plan member experience that mirrors the convenience and personalization popularized by retailers. By gaining a holistic view of member needs, barriers, and behaviors, payers will be better positioned to enhance member satisfaction and create customers for life.

Enam Noor is the founder and CEO of Insightin Health. Enam has spent the last 20 years in marketing analytics and consumer engagement and the last decade in healthcare member engagement optimization. He was the founder of Desme, a cloud-based strategic marketing consultancy that utilizes big data and machine learning to provide Business Intelligence automation. The company was named Top 10 Search Engine Marketing Firms by INC. Magazine. Enam was the key strategist for a Gartner CRM Excellence Award for healthcare member engagement and was honored by DCA Live as an Entrepreneur to Watch in 2018 for DC’s tech community.

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