The traditional interaction with payers has been around transactions: find a doctor or pharmacy, look up my benefits, and look up my claim. This is the transaction layer in the consumer relationship. There is little opportunity for a payer to develop a relationship and generate consumer stickiness in this area. Members, in this case, only go to the transaction layer to perform a transaction, which for any large payer is about one to two times a year. The main reason that many members perform a transaction is because they are going through a health event, a sickness or medical condition, and members are already in a stressed state of mind dealing with a personal or family health issue. This is not the best time to generate a relationship. The best way a payer can generate a positive experience in this layer is to provide superior support for the member when needed. This translates to a flawless experience by offering a caring connection, managing administrative tasks and processes, and performing event logistics so members can focus on their health. In order to build productive relationships, payers need to go where the people are and when they are in a good state of mind.

Figure 2 shows a representation of the HealthScape from a consumer perspective. There are three distinct layers around health and consumer involvement with the transaction layer being at the core. Each layer is different in how often members interact in each layer.

In the “Transaction Layer”, members may interact several times a year with a payer performing a health transaction. In the “Wellness Layer”, members interact far more often, such as one to two times a week depending on their personal plans for nutrition and exercise. When in the “Lifestyle Layer”, there is a potential for members to be involved in health every day, as it becomes part of a routine in a person’s daily living. In the “Lifestyle Layer”, a payer has the potential to achieve relationship nirvana - stickiness.


While in the “Wellness Layer”, members are focusing on sustaining or achieving a state of wellness. In this layer, he main issues on members’ minds are nutrition, exercise, and healthy behaviors. Members are focusing on their health to minimize the risk of becoming sick and leading a productive life. Members also begin to enter into a relationship with wellness providers and coaches to engage in healthy behaviors. Telephone coaching is an example of this. However, wellness is one of many personal priorities a member manages, so it may not be their top priority all the time. For wellness to be embraced a member must absorb healthy thinking into their life on a daily basis and it must become part of their lifestyle.

In a “Lifestyle Layer”, members interact, work, play and experience life every day. Examples of health in the “Lifestyle Layer” are the many new devices that monitor daily activity such as; sleeping habits and nutrition. The “Jawbone UP” and “Fitbit Flex” are wearable devices providing biometric data to consumers throughout the day. These devices provide feedback to members so they can adjust their actions and behaviors in order to reach their desired goals. These devices become part of the wearer’s lifestyle and that lifestyle changes based on the feedback they receive. If a member works in an office and sits at a desk too long, an alarm will go off, letting the wearer know they need to be more active and move around. If this happens often enough, their thinking will be changed and a new behavior formed, leading to healthy outcomes.

Healthcare payer solutions in the “Lifestyle Layer” focus on supporting consumers in their quest for sustained healthy living. It is important to help members approach health in a holistic manner and offer encouragement in the form of helpful tools that promote education in the areas of nutrition, exercise, stress, care, community and healthy living habits. In this layer, relationship maturity can blossom. To assist payers in their vision to diversify, they can take advantage of this opportunity in the “Lifestyle Layer” by offering such tools to reinforce healthy behaviors for their members and provide more than just health plans. The definition of health to a payer is more about healthy living for members and not just paying a claim.

Years ago, the same transformation occurred in the banking industry. Banks interacted with consumers simply by performing transactions such as depositing a check. Now banks offer a full suite of services such as financial planning for retirement, college savings and family growth supporting a person throughout their life.

An extension of a payer’s offer could be to aggregate data from multiple biometric devices to offer services to their members such as a health dashboard with relevant content to support decision-making and behavior changes in pursuit of healthier living. As mentioned under the “Engagement Section”, healthy behavior lowers the causes for chronic diseases, which in turn lowers medical costs in health care.

Relationship Maturity


Over the last three blog articles I talked about the importance of a good experience plus a product or service that does the job and how it is critical to building member engagement and the basis for forming relationships. It is important to remember that relationships in healthcare are important because a person’s health is very personal. Place payer services in the consumer lifestyle area and payers have an opportunity to gain trust and provide sustainable health engagement programs aimed at healthy living. Enablers, such as mobility and social, are available and affordable to build consumer solutions that integrate into a consumer’s lifestyle. Consumer centricity in healthcare is possible by focusing on consumers and integrating the fractured pieces.

If you were given a health biometric device to monitor your weight, blood pressure, heart rate, and activity, would you use it on a regular basis? How would it fit in to your lifestyle?

Point of View in Consumer Centricity