Healthcare’s Stumble Toward Greater Levels of Consumer Centricity and Engagement

The healthcare industry has traditionally sold the majority of its products and services business-to-business (B2B),  as opposed to direct-to-consumer or business-to-consumer (B2C).  Third party payers, care providers, prescription benefit managers (PBMs), and employers have largely focused their businesses “around” the consumer rather than “to-the-consumer” which, in turn, has led to a focus on automation and low-cost processing as a means of driving operational efficiencies.  This resulted in a natural barrier between the company and the consumer as the ty

The healthcare industry has traditionally sold the majority of its products and services business-to-business (B2B),  as opposed to direct-to-consumer or business-to-consumer (B2C).  Third party payers, care providers, prescription benefit managers (PBMs), and employers have largely focused their businesses “around” the consumer rather than “to-the-consumer” which, in turn, has led to a focus on automation and low-cost processing as a means of driving operational efficiencies.  This resulted in a natural barrier between the company and the consumer as the types of interactions consumers might prefer and demand were largely ignored and often considered secondary to the core objectives of the involved business itself.

However, health reform and the proliferation of high deductible health plans and other consumer-centric initiatives are driving industry participants to rethink and redirect their traditional business models toward developing new care and behavior intervention strategies focused on the individual consumer.

A considerable challenge to these efforts exists because most vendors have extremely limited experience in          identifying, accessing, and directly engaging the consumer demographic they wish to target.  A variety of consumer-facing vehicles such as web, secure portals, chat, SMS text, call center, and direct, personal interaction are being utilized in this process and their impact may prove substantive.

These efforts attempt to address the increasing demand for expanded, personalized, and continuous consumer      engagement across the continuum of health. Central to this are communication and analytical platforms.  Companies that have developed consumer engagement platforms tailored specifically for healthcare incorporate pertinent information on an individual’s demographic profile, health status, specific conditions, and risk factors and use predictive analytics engines to personalize interventions that might range from health interventions to education.

These “engagement platforms” have obvious value to the end user – regardless of their age, health status or needs.  At the same time, business participants across the healthcare continuum – from commercial payers and government program managers to PBMs, retail pharmacies, and various other healthcare providers – can also benefit from     implementing intelligent, consumer engaging programs.  For these parties, there are several key use cases:

• Improving medication and care regiment adherence,
• Lowering re-hospitalization rates through improved discharge planning and follow-up,
• Increasing member participation in preventive programs (e.g., routine physicals, colon/breast cancer screenings, heart health),
• Enhancing individual lifecycle management (including member on-boarding, proactive re-enrollment outreach, and member education programs),
• Appropriately reimbursing for risk-bearing public programs, and
• Tracking of clinical outcomes and quality improvement efforts.

Based on a range of factors, the U.S. aging population is one of the most challenging demographics to target, making it imperative that they are engaged early and often with information, options and calls to action.

Also, because of their high utilization of health services and prescription drugs, prevalence (or risk) of chronic      disease, and need for high levels of support and “hand-holding” in their activities, these multi-channel, targeted     consumer engagement approaches can have a tremendous impact on the health of seniors.

Health plans, employers, and other managed care organizations (payers) that are serving the burgeoning senior     population are increasingly being scrutinized to improve health outcomes while decreasing costs. The new technology-enabled solutions that leverage automated and electronic communications can help these organizations “extend” and increase the efficiency of their outreach, care management, health education and promotion, disease management, and administrative operations.

Automated communication solutions are also being utilized by health and wellness, disease management, remote monitoring, and other healthcare service providers to increase program engagement and compliance. An abundance of evidence exists to support the impact of these programs, but they have often struggled to produce a measurable return on investment (ROI) due a lack of consumer adoption. For this reason, behavior change continues to be a major focus for the companies in this space.

The effectiveness of programs designed to prevent, diagnose, and treat illness will continue to be limited without   increased consumer engagement and compliance – and is an area of healthcare we’re following closely.

Let us know what you think.

Seth Kneller