Healthcare Communication Solutions: A Tale of Two Models


As compliance demands and consumer expectations continue to rise, many payers and third-party administrators (TPAs) are struggling to keep pace. Payers who make it simpler for members to engage with their healthcare will be in a better position to drive loyalty and earn market share.

By: Maureen Strojny, Sr. Director Solution Strategy, Communication and Payment Services, Change Healthcare

As compliance demands and consumer expectations continue to rise, many payers and third-party administrators (TPAs) are struggling to keep pace. This isn’t necessarily new. Health insurance is consistently one of the lowest-rated industries—and at times, the lowest-rated industry—in terms of customer satisfaction. Previous studies show many members have very low engagement with their health plans.

In years past, payers could pass over these reports because the pain—for them and their members—was experienced industry-wide. That’s changing. Two conditions in particular have forced insurers to address communications with more urgency. First, big tech corporations are investing significantly in healthcare, and these companies specialize in delivering a satisfying consumer experience. Second, CMS’ price transparency and interoperability rules are making it simpler for members to shop for coverage. This, coupled with the shift in roles from member to active consumer, suggests a strong willingness to make a change for the sake of more convenience.

We’re finally starting to see some improvement. Forrester’s US 2021 Customer Experience Index showed that most health insurers improved their scores, especially when compared to other industries heavily affected by the pandemic.

Members pleading for a simpler experience are welcoming the evolution. Meanwhile, some payers wouldn’t mind hitting the pause button on the industry’s progress because they’re simply not resourced to streamline the member experience through the entire journey. Parts of it, yes, but not enough to where the fragmentation doesn’t reveal itself during multiple touchpoints.

Going forward, payers who make it simpler for members to engage with their healthcare will be in a better position to drive loyalty and earn market share. One key area is how payers can organize and integrate the communications workflow behind the scenes and how different integration approaches can impact member experience. For most businesses, improving customer experience is a top priority. It’s important for payers to have a system in place to create a dynamic member journey and improve customer loyalty and profitability.

Understanding Different Integration Approaches

On one end of the spectrum is a true in-house model, whether using homegrown or third-party CCM technology, which is designed to help companies that have an in-house marketing team to organize and have hands on the creation experience with their programs and campaigns. A managed services model, on the other hand, is meant for companies that want a team of industry experts to create and run programs and campaigns for them.

Typically, when a company wants to self-manage the end-to-end communications workflow, it requires a modernized IT infrastructure and staff, in addition to a dedicated marketing team. Often many payers attempt to make this in-house approach work without realizing that they ultimately don’t have the infrastructure, resources, and data synchronization needed to pull it all off.

Why does this happen? Well, right or wrong, self-service is easier to rationalize. Because communication is so central to healthcare, the natural inclination is to want control over every aspect of it. And it is important to consider the benefits and downsides of each approach.

Some of the benefits of a self-service model include payers and TPAs having direct control over their data and the ability to lower costs by scaling communications. However, data often comes from multiple unrelated sources. Aggregating, normalizing, and managing it can be complex and labor intensive. This presents a challenge for staff who may lack the expertise in the required technology and often operate in silos with different processes from other content managers. Also, high staff turnover can leave the payer without the necessary subject matter expertise, leading to delays and backlogs in communications, and ultimately a disjointed member experience.

One of the most important benefits of a managed service model is having industry experts to manage and guide the process, as well as maintain the technology itself. By incorporating service-enabled technologies, payers can achieve greater results efficiently with one workflow, one platform. A managed service model can also provide support for integrating, maintaining, and upgrading software to ease the burden of time and cost. One of the obstacles can be the upfront time of the overall implementation process, but it does result in an optimized documented work product.

First, payers and TPAs need to ask the right question. “Self-service or managed services?” is not the right question. The right question is “How can I achieve a holistic member communication strategy?” They need to think about the effect they want to have on member experience and how that aligns with the unique needs of their business. And then ultimately, they need to consider their core competencies and how to invest resources to achieve this vision.

With that in mind, some payers may consider a combined approach. Many organizations find a middle ground between an in-house and outsourced managed integration. This selection of approach is not a one size fits all model and it can evolve with the organization. We recommend considering strategy, resources, and technology to decide on the best approach for you.

Regardless of which option payers choose, the important thing is to have the tools and resources in place to streamline workflows, scale, and stay organized.

To figure out what those tools are, it’s important to start by setting goals. While challenges and items of importance will vary based on size, situation, and role (TPA), most organizations share the following goals:

  • Engage with members in their healthcare journey to improve outcomes
  • Grow and maintain plan membership
  • Drive costs down and improve operational efficiencies
  • Ensure operational compliance

Aligned with these goals, Change Healthcare offers seven different modules and supports the in-house, managed-services, and combined models outlined above to help payers address their needs through the full spectrum of healthcare communications.

Stay true to your story

Composing and managing member communications can get incredibly complex. Not only must payers and TPAs manage a vast-and-continuously-changing library of member communications, but they also need to make sure each piece stays synchronized within a complex ecosystem. Managing multiple vendors and disparate workflows only adds to the challenge for Payers and TPAs.

When exploring healthcare solutions, payers shouldn’t allow themselves to get caught up in a fantasy. Instead, they should stay focused on the mission and make sure the organization has the tools, resources, and expertise required to accomplish the short-term objectives without sacrificing the long-term vision. For payers exploring a fully integrated healthcare communication solution, a fairy tale ending is possible, but the plot has to be based on reality.

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