Healthcare Consumerization | Advanced Medical Reviews

Healthcare has changed drastically in the last six years, but these changes are not all due to the Affordable Care Act (ACA). Prior to changes in the way we purchase health insurance, advancements in technology and evolving patient preferences began to move the healthcare industry toward a more consumer-oriented landscape. This consumerization of healthcare is apparent in how patients shop for insurance, with more and more consumers expecting an enhanced level of customization. In the next few years, the healthcare industry may fully re-orient to serve patients’ needs ahead of the needs of other businesses.

Health Insurance Purchases Reshape the Industry

While the consumerization of healthcare is not entirely based on the ACA, the changes this law made within the industry are a major component of the shift. Prior to the ACA, individuals could seek out health insurance and purchase it on their own. However, few individuals had the resources to do this. There were little-to-no materials readily available to make comparison shopping possible and individual healthcare plans were notoriously expensive. Additionally, many factors like pre-existing conditions enabled providers to disqualify individuals from purchasing policies. With the passing of the ACA, everyone gained access to healthcare, and a majority of Americans are now required to purchase a plan. Within a digital marketplace, people can compare health insurance policies from a number of different providers and purchase plans that fit their needs and are within their budgets. This shift means health insurance providers must entice sales from individuals as opposed to businesses that would then provide insurance to their workers. Because health insurance providers must compete for individual purchases, patient preferences and expectations matter, similar to in a retail setting.

Patient Preferences During the Purchasing Process

When multiple retail brands compete for consumers’ attention and purchases, they must take personal preferences into account. A brand that offers information in one way through one channel will only gain business from consumers who happen to like that method of delivery. The same is now true for insurers. Health plan providers who want to reach the largest breadth of potential plan members must:

• Go mobile: It is not enough to be just online these days. Many patients check online websites and platforms through their phones or other mobile devices, RedPoint found. Providers’ sites must be mobile-friendly or better yet, they should offer an app.
• Have a multichannel reach: Consumers no longer interact with brands in a single way. Instead, they interact with brands through email, phone calls, social media platforms, apps, and online and video chats. Insurers must be set up to communicate with patients through more than one channel based on patients’ preferences and habits.
• Provide easy-to-digest information: Patients are becoming proactive in shopping around for plans that suit their specific needs. This means they require detailed information about healthcare plans in an easily readable format. Insurers must provide materials through multiple channels to enable patients to learn more about their plan options.

Consumerization Continues After Purchase

The healthcare industry is learning something the retail sector already knows: If customers are unhappy with a brand, they will move on to another one. Insurance companies now understand that engagement and customer service are necessary components to retaining a patient’s business, RedPoint stated. Providers must improve specific elements of their services to increase patient satisfaction, including:

• Engagement: Consumers like being engaged by their preferred brands, and patients want to be engaged by their health insurance providers. As Lisa Maki, CEO and co-founder of PokitDok stated, providers need to form relationships with plan members to fully engage with them and help them manage their health. Engagement extends beyond providing the plan benefits and traditional services. It might mean offering additional health education and wellness programs.
• Customer service: Just as consumers expect excellent customer service from retail stores, patients expect outstanding customer service from their insurance companies. A strong customer service and support team to handle questions, concerns, problems and appeals for denied services is crucial to maintain engagement and brand loyalty. This includes working with an independent medical case and utilization review provider like Advanced Medical Reviews to ensure patients receive the answers they need regarding potential treatments and insurance coverage as soon as possible.
• Personalization: Providers that intentionally gather more pertinent and personal information about their plan members can tailor their members’ experiences. The Institute for Healthcare Consumerism recommended insurers learn patients’ preferred names, language preferences, diets, religions, reminder preferences, payment preferences and more. Once providers have more detailed information, they can customize communications and customer service interactions.

The consumerization of healthcare was in full swing in 2016, and we will continue to see providers make changes to better engage with both potential and current plan members and improve member satisfaction.

Heading into the new year, the healthcare industry can expect consumerization to only grow from here. This is especially true in light of the recent election. Should President-Elect Donald Trump’s campaign agenda ring true, the healthcare industry will be reformed with free market principles in mind, as the next Commander in Chief will open up health insurance sales across state lines. The greater competition created by this legislation will require payers to consumizerize their approach even more and focus on key principles of customer service, engagement and personalization.