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Improving Customer-Centricity for Healthcare Payers

Improving Customer-Centricity for Healthcare Payers

By Rachit Dhir
May 17, 2016

The conversation in healthcare is changing from “patient engagement” to “consumerism”. This change indicates a new approach to thinking about patients as consumers to deliver a healthcare experience as consumer-centric as many other industries. Payers specifically are becoming extremely customer-centric and encouraging members to become more active participants in their own healthcare. According to John Quelch, Professor in Health Policy and Management at Harvard T.H. Chan School of Public Health “When healthcare costs are very high, as they are in the United States, the industry has to focus on cost efficiency and centralized regulations that are designed to rein in those costs.” A customer-centric approach can work to change this scenario by shifting the focus to involve consumers in their own care processes.

To accomplish these objectives, Payers are reviewing their customer journey to improve the overall consumer experience. Analytics is enabling payers to deliver an enhanced customer experience across the entire customer journey by improving the buying experience for new and existing customers, helping patients manage their health, resolving customer complaints and adapting to customer’s evolving needs.

Analytical solutions have helped Payers develop a comprehensive Consumer Profile by creating descriptive and predictive behavior markers called ‘customer genome markers’ to micro-segment customer groups and map targeted interventions that improve health outcomes, enhance customer satisfaction and lower the cost of care.

This approach to customer segmentation helps Payers dynamically identify members most likely to contract a chronic disease, track a disease’s progression among members, identify patients likely to not adhere to medication or predict members likely to make an unnecessary ER visit. It also helps Payers identify members showing dispersed care patterns or struggling to find an in-network doctor, that indicate they need help navigating healthcare decisions. Addressing these key issues with the help of analytics is resulting in better customer engagement through improved population health management.

Similarly, dynamic segmentation helps Payers measure customer sensitivity to price changes, optimize channel strategy for improved response and experience, and determine if the newly acquired customer will eventually be profitable or not. With a deeper understanding of customers, Payers can make data-informed decisions to create a better shopping experience for their customers. To help better manage operations and resolve customer issues, dynamic segmentation helps identify customer preferences such as when and how to update their claims status, billing or benefits, and helps flag customers at risk for attrition. Lastly, it helps determine which customers may need additional coverage and benefits based on their changing preferences.

In summary, analytics can help drive improvements in the health plan customer experience by:

  • Making the enrollment process simple and rewarding for customers
  • Effectively managing patient’s health needs and care decisions
  • Quickly resolving concerns related to billing, coverage, and claims through the customer’s preferred channels, and
  • Helping customers to find additional products and coverages based on their changing life situations

Payers that are able to guide the customer experience and understand and respond effectively to customers’ needs and preferences will earn their customers’ trust and loyalty.


A Roadmap to Improve Customer-Centricity in Health Care


About the author

Rachit is a Vice President and head of Healthcare & Insurance consulting at Fractal. He has over 12 years of corporate experience in analytics consulting, solution design, business development, and global analytics delivery. Rachit has led large analytics engagements to deliver high-impact business results for Fortune 500 organizations in the areas of population health management, payment integrity, network optimization, consumer experience, marketing & distribution and claims. He has experience in consulting CXO and functional head level audience of clients on designing and implementing analytics led business strategies and business function-specific analytics roadmap.

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