A New Mindset: How Payers Ensure a Successful Digital Transformation

The pandemic has left a lasting mark on the healthcare industry, accelerating digital transformation and forcing organizations to rethink their roles in helping consumers access and benefit from innovations in care delivery and management.

Payers have come to the fore. Over a brief period of time, they have made inroads shifting from simply paying for care to enabling members new levels of access to and engagement with the healthcare system. But to build on their success, payers must be strategic moving forward and ensure they provide meaningful services personalized to the end-user. Success hinges on their ability to achieve internal alignment, support targeted innovation, and drive utilization in a way that improves satisfaction and reduces cost.

Payer as a service

Health plans are more than payers: They design benefits to suit members' needs and help make the most of each healthcare dollar spent. But payers still face a perception problem. The solution lies in an evolving understanding that they are, in fact, service providers.

"The pandemic accelerated change, and healthcare companies started to realize they are actually service companies," says Emids Vice President of Experience Jennifer Fraser. "They need a different focus — they need to look internally at their organizations and externally at all touchpoints with their customers, employers and members."

For payers, that means shifting the focus from transactions to experience.

"A holistic approach needs to center on desirable experiences. And that's a huge shift from an organizational perspective regarding how they think about planning, designing, and releasing products and services," Fraser adds.

As budding service providers, payers must also be aware of the need to personalize those services. 

"Digital transformation also depends on bridging connections between tools and services so that good data can lead to more personalized experiences for the individual members, leveraging artificial intelligence and automation to provide that tailored experience. That is at the heart of payers knowing their members and meeting them where they are," observes Emids Vice President of Digital Consulting Lorraine Chapman.

Big picture, small parts

To move in the same direction, payers must be aligned. Competing interests can quickly derail efforts to effect change. Consensus is key to driving innovation forward.

"It can take some time to get a product to market. Sometimes, competing desires and wishes can cause a project to lose sight of its focus," Fraser notes. "It's important to look at the release of your product, or service, as a series of releases. Determine what's critical for that initial release and be relentless with the focus on the scope for that release. Get it out there, then build on that momentum with the following releases while measuring and adjusting as you go to achieve success."

While the pandemic and market forces have ramped up pressure on payers to modernize and evolve, they should not prevent these organizations from losing sight of the big picture and being deliberate about the smartest path forward.

"They need to take a step back and look at things holistically," Fraser continues. "Where are they going to get the best return on investment? They truly need to look at digital transformation across the life cycle of their products and services. Does it make sense to build from scratch, leverage a low code solution, take a white-label approach, or license a content provider? There are so many things they need to take into account while also being mindful of the investment they are making."

Holistic thinking must also extend to data and information management, given healthcare's penchant for creating silos that hamper innovation.

"Data silos within payer organizations remain a major problem," Chapman emphasizes. "To provide this seamless experience to members, they need their different systems to talk to one another and their staff supporting the members to be able to access timely and complete information. Data management will be a key factor in helping payers evolve and deliver better services to their members as they engage with them."

Knowing what to measure

Member engagement is a major focal point for payers and their digital transformation efforts. Many have set out to create tools with the goal of seeing high adoption among members. But payers could very easily be missing the point.

"One of my pet peeves is hearing that measuring member engagement means using the tool all the time when that might not be what you want. That could mean members are not getting the information they need, and it becomes a frustrating experience. There are always going to be success metrics from a business perspective and the member and financial perspective," Chapman explains.

"What's important are outcomes. In terms of member engagement, a great experience is members getting in and getting out with what they need. From the organizational perspective, reducing time to assist members and improving health outcomes are good measures. But, ultimately, metrics need to be outlined, tracked, and validated on an ongoing basis. It's not one-and-done."

According to Fraser, payers need to think differently about measuring success as they function more as services companies assisting both purchasers and subscribers.

"As a services company, you're continually releasing, measuring, evolving across the lifespan of that product or service and thinking about it end-to-end and continually monitoring the efficacy of what you've done. That same diligence needs to be applied to improve the experience for everybody," she adds.

Successful achieving outcomes starts with a wide vision, an overall strategy that aligns the entire organization and makes clear how all the constituent pieces fit together.

"Our approach is to help develop a vision, knowing where the goal posts are and ensuring everybody's aligned on that vision. Ultimately, this is what you want to achieve. These are the outcomes you want to see at the end of the day," Chapman concludes.

Payers have become services companies and must think differently about how they enable members to access and utilize the healthcare system. To bring meaningful services to market more quickly, they must align their focus internally to identify where to target their innovations. And by breaking these initiatives into smaller parts, they are better able to build and sustain success. Working with a strategic partner can allow payers to properly assess their strategies for digital transformation and determine the best path forward.

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About Emids

Founded in 1999 and based in Nashville, Emids provides global digital transformation solutions across the healthcare ecosystem, providing tailored, cutting-edge solutions and services in the domains of engineering, design, and system management for payers, providers, biopharma, medical technology and healthcare technology firms. Emids’ core values as trusted guides and inclusive innovators obsessed with delivering impact and value for its customers are the cornerstones of its singular mission of advancing the future of health through impactful technology solutions. Learn more at www.emids.com.