Creating a Better Consumer Journey in Healthcare Insurance

Let’s look at two scenarios we’ve all experienced. Sally went to the local ER with a pounding headache. She was examined by the doctor and taken for a CT scan. Once the test came back clear, Sally was released, with a migraine. Although Sally had great insurance — a PPO with numerous benefits — a month later, she received a bill for $1,000 after her insurance paid its portion. She had no idea how much she would be paying out of pocket when she went to the ER. 

The following week, a diagnostic light appeared on the dashboard of Sally’s SUV. When she took her car into the shop, she found out she needed new front brakes. The cost? $1,000. Knowing up front how much the repair would cost, Sally signed an agreement authorizing the dealership to complete the repairs. 

Contrast these two scenarios: Same cost. Similar outcome. Different consumer journey. 

Today, every healthcare consumer is seeking the same things: price transparency, improved quality and services, access to personal data and a positive consumer experience.   

According to McKinsey & Company, more than 60% of patients want more information before making healthcare decisions, and yet only a fraction say they have access to it, so nearly 49% follow the recommendation of their doctor, clinician or insurer without considering better, lower-cost or more convenient care options.

Simply put, providing consumers with better and more accessible information about their healthcare and treatment options has a profound impact on their overall healthcare decisions. 

How can healthcare insurers create a better overall consumer experience? 

As 24/7/365 consumers, we want all of our services under one plan, and we want to own our healthcare journey. To get there, we need three things: 

  • More transparency in price and provider choices. Whether an elective or emergency procedure is needed, or a headache lands you in the ER, it’s difficult, or nearly impossible, to determine these costs ahead of time. This lack of transparency seems archaic in 2021.

    Consumers want healthcare costs to be comparable and shoppable and use this information to make better decisions and prioritize their healthcare spend.
  • A single source of member data. Hospitals, insurers, and doctors currently operate on multiple data platforms and systems with siloed patient information. Without the ability for each system to communicate with the other, it can be impossible to get answers or find actionable information. Ideally, a doctor at the hospital should be able to access your electronic medical records, prescription drug plan information, therapy deductible and physician privileges while weighing the next course of treatment. 
  • Improved experiences and coordinated care between providers. Consumers seek a more personalized, seamless, and digitally enabled healthcare experience. It’s about care coordination between the customer service representative and all clinicians. When speaking with a customer service representative for their insurer, for example, patients want to understand why they aren’t eligible for a specific drug their doctor is prescribing. And yet the customer service agent doesn’t have the answer. He or she may transfer the patient to the pharmacy department, where they receive the same response. Consumers want better coordinated care between all of their care providers: knowing, for instance, why they can’t get a certain drug and what their other options are.

The path to a better health insurance consumer journey 

To improve the consumer healthcare experience, all providers — the hospital system, doctor’s office, insurers and pharmacies — must work from a single source of data in which the patient’s entire history, payer sources, and healthcare history is searchable. 

This will require technology that’s flexible, open, and able to support rapid integrations. Unfortunately, the legacy mainframe and policy administration systems many insurers currently operate can’t support such a cloud-enabled ecosystem.

EIS’ coretech platform can. Its open-API structure enables all payer and provider systems to connect with each other, champion data transparency and increase scalability and the event-based workflows necessary to ultimately facilitate the type of transparency consumers seek. Explore a new consumer healthcare journey with EIS — one in which transparency, a single source of patient data, and quality of service rule. 

For more on how to meet health insurance consumer expectations, check out our eBook, Reducing the Risk: The Path to Digital Transformation in Healthcare.

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