The Connection Between e-Adoption and Profitability in Healthcare

Whether you call it digital transformation, digital disruption, innovation, or something else, it’s clear that technology is drastically changing the healthcare landscape. From member communications to care navigation and management, many leading health plans have embraced tech-centric business models that respond to member needs. While some traditional-leaning executives have been slow to digitize, the COVID-19 pandemic made it evident that this isn’t just a pie-in-the-sky concept or trend. It’s a requisite for success.

Cost is almost always the biggest barrier for health plans. When considering all of the processes that require digital technology – member interactions and communications, financial transactions, internal business operations, administrative tasks, contracting, etc.  – the potential expenses can be daunting. That’s why it’s critical to direct investments toward initiatives – and partners – that satisfy the most pressing, near-term goals, while ensuring the organization is prepared for the future.

Putting the Customer First

Efforts affecting the member should always rise to the top of your innovation to-do list. According to a 2021 Deloitte survey, 57% of health plan technology leaders seek better customer service and engagement as the most desired outcomes of digital transformation. Furthermore, customer experience-related metrics will determine more than 50% of overall New Stars ratings for Medicare Advantage by 2023. In essence, Medicare plans with quality experiences will receive higher ratings, which directly impact plan profitability.

Superior experiences must become the norm, not the exception, if health plans want to obtain their share of Stars-linked incentives as well as other revenue opportunities.

Maximizing ROI

A McKinsey study showed that some health plans have already uncovered value from their digital investments. They’ve cited improved customer experience, reduced administrative and medical costs, enhanced member health, and revenue growth. Many of the large, national payers have even partnered with tech and data analytics companies to increase the speed and success of their digital transformations.

At O’Neil, many health plan clients report numerous bottom-line benefits following the adoption of ONESuite, a data-driven customer communications management (CCM) and customer experience (CX) platform.

Some of the greatest ROI opportunities include:

1. Decrease administrative & operational costs
Across the industry, health plans are building toward digital-first member engagement journeys. While there likely won’t be a complete overhaul of printed health plan documents, the pivot toward digital communications lightens a variety of administrative costs, including printing, mailing, postage, distribution, etc., for your organization.

Additionally, many payer-centric activities, such as data collection and data processing, can become automated processes using sophisticated CX technology. The McKinsey study referenced earlier explained that automation can yield significant cost savings that range from 15% to 40% depending on the nature of the work.

2. Foster cross-functional collaboration & efficiency

In the past, digital technology was treated as a back-end function limited to IT or data analytics teams. Many health plans implemented functional approaches and silos as a way to bolster individual department performance. However, true digital transformation depends on consistency and collaboration that transcends departmental boundaries.

Integrated platforms like ONEsuite give various stakeholders greater visibility and proximity to customer intelligence. Representatives from sales, marketing, customer service, IT, business research, etc. can come together to analyze needs and deliver a comprehensive, end-to-end experience. Ultimately, organizations can eliminate operational inefficiencies, communication gaps, duplicate efforts, and wasted time. 

3.  Enhance member experience

Beyond reducing paper and postage expenses and improving internal processes, digital technology presents new, affordable ways to interact and communicate with plan members. By using ONEsuite’s analytics, sales and marketing teams can create deeper audience segmentation and deliver highly customized omnichannel communications across the member experience continuum. You can help them select optimal benefits for themselves and their families, access appropriate medical care, utilize member portals, navigate health systems, participate in cost-reducing wellness programs and so much more. Most importantly, you can anticipate service needs before they even come into a member’s awareness. Ultimately, these capabilities fuel better experiences, member retention, and of course, revenue growth.  

4. Lower medical costs

According to the Centers for Disease and Control (CDC), 60% of Americans have chronic diseases such as heart disease, diabetes, or kidney disease. Many of them have two or more chronic conditions, increasing the complexity and costs of managing them. Digital solutions that combine machine learning and real-time analytics can identify members in need and engage them through proactive communications that address condition-specific factors. Approaching chronic disease management, Social Detriments of Health, and other health issues in this way not only keeps member medical costs in check, but reduces overall expenses for your organization without impacting quality.

5. Drive successful outcomes

Overall, less administrative hassles and costs, better cross-functional collaboration, superior member experiences, and lower costs create major wins for everyone. Health plans can glean insights about members, allowing them to expand services and improve access to the right care at the right time. Healthcare providers gain a tighter bond with their patients and can make informed timely interventions. Most importantly, patients trust that their health plans and providers have their best interests in mind, leading to better health outcomes and experiences.

Contact O’Neil

The digital ecosystem is ever-changing. Health plans must keep an eye on emerging technologies and vendors that can accelerate the speed of transformation. Know what you’re looking to achieve in both the short and long term, and ensure you’re striking partnerships with solutions providers that put member needs and experiences first. O’Neil helps a variety of health plans maximize their customer experience and communications management strategies. Contact us for a free 15-minute consult or to preview our ONEsuite platform.