Avaya StaffApril 09, 2021

Healthcare Payers Need to Update their Technology to Compete

This blog was written by Elka Popova, Frost & Sullivan, Connected Work & Digital Experience Vice President and Senior Fellow & Sonya Denysenko Frost & Sullivan, Global Digital Health Director.

With the global healthcare market expected to grow by as much as 5% in 2021, the industry is poised for significant change as recovery and rebound takes effect. Nowhere is that more apparent than in the life sciences and digital health markets, which offset the decline in 2020 revenues in the medical device and imaging sectors; those areas will have softer rebounds in 2021. Furthermore, growth opportunities now extend beyond just point of care, and both pre-diagnosis and post-treatments across the value chain are part of the virtual-care transformation. This will increase the length and breadth of the customer lifecycle and put more focus on the overall patient experience.

The convergence of technology and healthcare has changed the game in numerous ways, including the use of fitness devices and apps, sensors, monitoring tools and other cloud-based diagnostics; virtual care, available anytime, anywhere (including via video conference); and the use of artificial intelligence (AI) and data analytics to improve care and provider outcomes. Value-based care continues to play an integral part in the shift in healthcare dynamics as both payers and providers work on new operating models focused on the “quadruple aim”.

On-demand software tools are transforming the delivery of care across the healthcare spectrum, with significant growth expected in telehealth and patient-engagement software. Home hospitalization has become more common, especially with the momentum of recent CMS reimbursement rules, offering cost savings, faster times to recovery and enhanced patient outcomes. Precision health and population management, aided by AI, are shaping critical care guidance and improving patient wellbeing.

What does this mean for companies that want to stay competitive in the industry? Communications between customers and providers is more important than ever. This is especially true for the payer-member experience, and healthcare payers need digital customer experience solutions that are designed just for them. The goal is to deliver higher value, stronger ROI and better outcomes.

Enabling effective communication and collaboration across the healthcare ecosystem improves the patient/member journey every step of the way: from diagnostics and provider-driven care to employers’ HR team and relevant payers, as well as often-ignored components like medical devices, pharmacies and regulatory requirements such as HIPAA. By integrating collaboration among all these customer-care points, payers can boost customer value, save money and improve overall outcomes.

But is your customer experience system ready to handle the new digital era?

Leading providers are making the customer care department a key area of focus for digital transformation, using customer satisfaction rates to measure success. Improving the customer experience is the main business goal for almost a third of healthcare IT decision makers; no wonder they are investing heavily in customer experience management solutions to make it all happen.

And plenty of businesses are using more-advanced technologies to get there. For instance, 61% of healthcare organizations surveyed by Frost & Sullivan expect AI to help with this transformation. AI can dramatically improve the customer experience by applying context and analytics to more complex interactions, ensuring customers get the information they need quickly and accurately and helping agents deliver maximum value whenever and wherever they engage in person.

Meanwhile, agents want to be able to offload the mundane tasks that lead to boredom and churn. By automating basic processes with AI, companies allow agents to work on the high-value interactions that keep them interested and valuable to the organization. Better still, AI can dramatically improve the Key Performance Indicators (KPIs) that contact centers are measured on.

To enable this digital transformation, many organizations are embracing micro-services platforms and composable experiences. Both make it possible to deliver new applications and features quickly and easily, even as part of relatively large and complex software suites. That’s especially important these days, as healthcare providers and payers find themselves in an increasingly competitive marketplace that is also constantly changing due to new regulatory requirements and government mandates, to say nothing of global disruptions from weather, economic factors and, yes, pandemics.

To leverage all these new capabilities for maximum benefit, healthcare organizations must:

  • Find the right balance between self-serve and live customer assistance, making investments that ensure a seamless and personalized customer experience.
  • Enable tight collaboration between customer-care staff and subject-matter experts, as well as patients themselves.
  • Future-proof technology investments by leveraging micro-services-based platforms and consumable building blocks.
  • Custom-tailor member experiences and optimize workflows using flexible APIs, CPaaS technology and programmability.
  • Capitalize on the power of AI and conversational analytics to better support member interactions with self-serve tools and fully engaged staff.

To learn more about how your organization can compete, join us for the 'Trends & Technologies for Healthcare Payers' webinar on April 20, 2021.