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Who Will Decide Health Insurance Winners and Losers? Part III

AcxiomOctober 27, 2016

Winners will close the gaps by leveraging strengths and addressing weaknesses, while losers will confront them through attempts to control opportunities and by using threats.

In my role at Acxiom I regularly attend health technology conferences where participants in a substantial number of the keynote and panel sessions share perspectives on how consumers will shape the future of our nation’s healthcare system. A common point speakers make is that consumer expectations are to be able to interact and conduct commerce digitally and that the bar is set by tech titans such as Amazon, Apple and Google. While it’s an easy point to make since it resonates so intuitively with the crowd, rarely does the audience get a succinct explanation as to how and why. In the last in a three-part call-to-action, I encourage further exploration of this point, which is critical to filling one of the major gaps in the tech-enabled modernization of healthcare.

What gap is that, you ask? First allow me to illustrate with some of analogies outside the healthcare sector. Think about the way consumers today balance their bank accounts. How about crunching the numbers on rollover usage for a smart phone data plan? Neither requires any more sophistication than logging into an app, because the software design has reached a point where de facto industry standards, i.e. consumer expectations, dictate a user-friendly interface enabled by real-time data. Long gone are the little account books a prior generation reconciled while waiting in a teller line, and the trend toward paperless utility billing has nearly played out.

I believe it’s safe to assume, without any hand-wringing on the brokenness of our nation’s healthcare system, that at some point in the foreseeable future a modern consumer will be able to say: “Hey Siri-Alexa-Cortana, where can I get a quality, economical MRI near me?” and instantaneously get a credible answer. Yet, 87 percent of consumers receive medical bills via mail, and a large majority still get explanations of benefits (EOBs) the same way. Clearly, real-time transactions, transparent accounting and easy-to-access and use user interfaces is an obvious gap that revenue cycle stakeholders, chief among them health insurance insurers, must close to raise the standard of commercial experience to the level consumers now expect.

What’s standing in the way of real-time transactions and accounting in our healthcare system? Volumes could be written about the tangled web of incumbent intermediaries between payers and providers with their fingers in the revenue cycle pie. Instead of undergoing a cumbersome examination of unwinding the myriad complex business relationships and payment processes, a prudent approach would be to simply ask:

 What are the viable alternatives that have already elevated the standard means in the revenue cycle to enable an agile pivot toward delivering a modern consumer experience?

Amazing as it may be, there are real-time healthcare transaction enablers out there; and the healthcare insurers that will win in the future will find them if they have not already. These winners will leverage their market strength to encourage trading partners to modernize, while proactively addressing weaknesses on the progression path toward modernization. Losers, on the other hand, will co-opt intransigent intermediaries that attempt to control opportunities by issuing threats laced with fear, uncertainty and doubt.

But why should health insurers accelerate their efforts to enable a real-time revenue cycle? Although many might find the answer implied in the industry analogies and final punch line, it’s worth elaborating. The Holy Grail for any brand to influence consumers is true engagement, and even though healthcare is special, it is a common denominator across all B2C industries. Consumers will only sustain their engagement if there is a real value exchange for it. Right now the primary value proposition health insurers are making to the consumers they desperately desire is simply peace of mind. The winning healthcare insurers will up the value ante with real-time transactions and accounting, and when employer group clients demand it there will be definite losers among the unprepared plans. A recent Cognizant report, The Digital Mandate for Health Plans, concludes:

“Consumers want digital tools and mobile-first options to manage their plan. … The digital capability needs of members covered by employer-group sponsored plans are increasingly aligned with those who purchase individual insurance via direct-to-consumer channels.”

To get there, the journey for modernizing healthcare insurers will be long. However, distance easily can be overcome by speed. In my next series of blogs, I will highlight fast-moving and forward-leaning, rapidly deployable innovations, enterprise-level initiatives and pragmatic approaches already closing the gap on the consumer-centered modernization of healthcare.

Here’s to overcoming gaps … and gaining a clear view to new horizons!