insurance.payer.trends.2016.jpgConsumerization in the insurance industry has changed healthcare payers' perception of what one person is ... as a whole.

A new IDC Health Insights report, released during February 2016, titled Business Strategy: An Architectural Strategy Driver for Payers – "Patient of One" examines the opportunity of payers to strategically and technically appreciate, respect, and optimize the concept of a consumer as a whole person, both as a member and a patient. 

The report's author, Jeff Rivkin, IDC Health Insights Research Director for Payer IT Strategies, suggests optimizing the project portfolio and architectural strategy around a central question: "Does this initiative drive the company to the 'Patient of One' principle?" 

According to IDC Health Insights, the report shares the following takeaways:

  • The 'Patient of One' concept helps focus the payer organizations on the consumer and centralizes the architectural approach upon the project portfolio. This portfolio approach will counteract the increasingly decentralizing forces of line of business (LOB) funding, IT point solutions, cloud-enablement, year-to-year funding, and the enrollment renewal focus.
  • Currently provider information is disjointed and administered all over the payer organization, yet consumers demand updated, accurate information from an increasingly individualized, diverse set of providers.
  • Clinical patient data is evolving in the medical management or care coordination arm as utilization and disease management migrates to universal care coordination.
  • Administrative Member profile and event data is held in enrollment, claim, and/or payment systems.
  • Marketing and sales are awakening to consumer acquisition, win-back, and speed-to-market paradigms that have been standard in other industries, but are relatively new to payers.
  • With the advent of cloud technology and the increasing decentralization trends of empowered LOB (individual, group, governmental), there will be a temptation to buy point solutions to attack these islands of data and strategy with particular technologies. Vendors will sell to LOB, and LOB themselves will perceive that their needs are met, giving them flexibility.
  • IDC asserts this scatter-shot momentum must be tempered by an overall strategy and central architecture around a focus on the Patient of One.
  • According to IDC Health Insights, today's payers have disconnected from customers over time; separating the person from the transactional unit processed by the company. Payers separated the patient from their medical service via a claim, the subscriber from their care requirements via a generic one-size-fits-most plan from an employer, the patient from their diverse provider desires via a specified limited network, and the customer services desired via a call center script or website.
  • Bill payment focus, mass marketing, internal departmental applications, and claims emphasis is now replaced with data sharing, consumer personalization, enterprise focus, and a partner-in-care mission. Over the next 24-36 months, successful payers will take holistic approaches around the 'Patient of One' and will unify their strategies and technology portfolios with that integrated mindset.

insurance.payer.trends.2016.patient.jpg"Consumer demand, network adequacy and directory legislation, virtual care, and more sophisticated network designs will drive 'Provider of One'," Jeff Rivkin, IDC Health Insights Research Director for Payer IT Strategies, stated in a press release shared by IDC Health Insights. "Evolving retail-like Omni-Channel marketing approaches and enhanced segmentations will drive Prospect of One. Breakthrough payer-specific CRM technology and cross-LOB approaches will drive a combined interoperable Administrative 'Member of One' and Clinical Patient of One. So, individual drivers are appearing. The architectural challenge will be to take a global approach around the universal Patient of One."

Read Also: 5 Ways Healthcare Payers Embrace Member Communications

IDC Health Insights concludes that, without this approach, dissatisfied consumers will elect their newly-found option to switch payers frequently, focus on price, cherry-pick, and adopt a short-term mindset in an industry that has deep cultural and administrative roots assuming loyal, renewing members. Costs of acquiring or "winning-back" members are well-documented as being up to five times as much compared to renewing. In an industry stressed by cost, this will be prohibitive.

IDC Health Insights assists health businesses and IT leaders, as well as the suppliers who serve them, in making more effective technology decisions by providing accurate, timely, and insightful fact-based research and consulting services. 

Did You Know? Paragon Solutions delivers an integrated communications solution framework to some of the largest healthcare payers in the United States. As a leader in insurance advisory and systems integration services and healthcare payer relations, Paragon provides expertise in Summary of Benefits and Coverage (SBC) content automation, including automated approval workflow.