How to Elevate Your Health Care Customer Experience for Engaged Consumers

Health care consumers now expect the same type of seamless experience they get from Amazon and Uber

Sponsored by West Monroe Partners

Outside forces—from consumerism to health care reform, to digital evolution—have created a marketplace where individual consumers are more engaged than ever before in purchasing insurance and managing their health and wellness. For health care organizations operating in this evolving marketplace, success and competitiveness is not just about being the “best.” It is about delivering an effortless experience that meets—or, preferably, exceeds—health care consumers’ expectations.

When choosing which health care services to purchase and consume, today’s consumers will consider a host of factors that include traditional criteria such as cost, reputation, and quality of service. But they are just as likely to prioritize experience. Do they have easy access to the information they need and want? Can they connect when they want and through the channels they want? Do they receive timely and personalized communication?

What’s important to acknowledge here is that the benchmark for health care customer experience no longer comes from just the health care industry. It comes from the wider marketplace, where companies like Amazon and Uber have set a high standard for shopping and customer service experiences. Health care consumers and patients expect the same type of seamless experience when interacting with insurance and provider organizations.

The struggle to deliver on expectations

In 2016, West Monroe Partners surveyed more than 1,300 health care consumers and conducted a roundtable with health care insurance executives representing plans with member volumes ranging from less than a million to more than 15 million. The purpose of the study, No More Waiting Room: The Future of the Health Care Customer Experience, was to understand how today’s consumers interact with health care providers and payers and how communication preferences are shaping the industry. Findings point to a misalignment between consumers’ expectations and health care organizations’ confidence in delivering on those expectations.

For example: One third of health care consumers have used a mobile app to communicate with a provider in real time. 80% of consumers who have communicated real time via a mobile app prefer this method to a traditional office visit. Yet, 85% of health care executives aren’t confident that they have the right technology in place to evolve patient experience, and 54% aren’t confident they have the right processes to do so.

Start by putting health care consumers first

The health care marketplace is extraordinarily complex, with shifting economic realities, complicated products, emerging channels, and regulatory changes. Insurers and providers that are able to simplify this environment and make it easier for consumers to buy and access health care services stand to gain significant advantages—lower delivery and administration costs, greater patient and member retention, and better patient-centric decision making.

Creating a winning consumer/patient experience starts with a shift from an “inside-out” to an “outside-in” viewpoint—employing a customer experience vision that mobilizes operations and technology solutions around people rather than around traditional enterprise boundaries. Some health care organizations have begun designing from this perspective, but delivering on it is proving to be a considerable challenge. The entire organization and ecosystem—from the executive suite to the front line to the back office—must be involved in shaping consumer experience. It will also require modernizing the systems and technologies that touch consumers and engage them throughout the management of their health.

Following are several keys to adopting a consumer-centric view:

Personas and journey mapping

Developing customer personas and mapping a health care consumer’s “journey” while interacting with the organization are effective techniques for creating an “outside-in” view of operations. Personas identify the various buyers—providers, brokers, patients, prospects, and members—and reveal their feelings, motivations, and attitudes when dealing with an organization. Journey maps identify all touch points, from origination of the relationship through continuing delivery of health care services. A journey map will look at factors such as the channel of interaction, the content, and the user experience. Typically, journey mapping involves conducting interactive workshops with members/patients as well as internal stakeholders. This technique is useful for understanding the customer, the current journey, and how to design the future customer journey and experience.

It is essential that all facets of the organization—sales, marketing, network and care management teams, back office functions such as billing and call-center support, and others—participate in this exercise. Not only does this prevent interactions from being designed in “silos”, it also helps the individuals involved adopt a consumer-centric viewpoint.

Consumer data

Data is the foundation for understanding needs and behavior motivators and a key part of building strong consumer relationships. Patient and product histories, along with analytics, allow organizations to gain an inside look into how patients interact with payers and providers. Learning about and adapting to consumer preferences can boost engagement and create trust.

Health care organizations need to begin developing tools and capabilities for analyzing and assessing consumers—from their engagement with campaigns to their interactions with health care products, services, and channels. They also need to be able to translate that data into plain messages that give internal operational personnel what they need to know to improve experience.

Finally, to improve care and deliver a better experience for patients, these organizations will need to develop capabilities for sharing data effectively and securely across the health care ecosystem of pharmacy, clinical, providers, and payer organizations.

Segmentation and experience strategies

Having engaged customers helps manage costs and improve care. But the same engagement approaches don’t work for everyone. Some health care consumers prefer to pick up the phone to interact with an insurer or provider. Others prefer to do so online—and, as noted above, some prefer mobile interaction. Some are proactive about managing their own health, while others are less so. Some want lots of information, and others want information only as their interests warrant.

Engagement starts with effective segmentation of the patient population. There is no “one-size-fits-all” approach to building relationships. Developing consumer segments allows the health care organization to focus on the different needs and behaviors of a group of individuals. Each segment should have a defined relationship strategy that supports the overall brand identity but reinforces a segment-specific value proposition. From this, the organization can design engagement and experience strategies to accommodate each segment’s channel and information expectations.

Personalized communication and experience

Today, many health care organizations limit communication to e-mail, mail, and phone. These channels typically are one-sided and do little to engage customers. More significantly, this is problematic considering the rising generation of health care consumers prefers online portals, mobile channels, and messaging platforms. While the survey suggests organizations intend to rectify this, time is running short. Given the accelerating speed of technology innovation, by the time they add platforms like social media and instant messaging, they will be behind.

Omni-channel approaches, driven by customer data, will be necessary to deliver personalized messages and drive engagement. Health care organizations should be leveraging technology to develop user-friendly interfaces and self-service tools that allow patients to engage the organization through their channel of choice.


Finally, health care organizations will need a supporting infrastructure to orchestrate relationship development. An engagement architecture comprised of profile, preference, campaign automation, channel, content, and interaction-management capabilities is necessary for executing designed experience and measuring success. For most organizations, this will require a more flexible delivery environment and agile development capabilities.

Enabling sustainable change

Creating the capabilities for putting—and keeping—consumers at the center of operations is a key starting point. Once that is underway, organizations will need to start looking at their operating models to identify functional improvements that have the biggest impact on consumer experience and that allow them to react quickly to evolving trends and competition. Finally, change of this magnitude will require cultural and change management initiatives to ensure that the organization embraces customer centricity and that investments in change are sustainable.

West Monroe is a progressive business and technology consulting firm that partners with dynamic organizations to re-imagine, build, and operate their businesses at peak performance.


How to Get Ahead of Employer Health Care Costs to Effectively Manage Risk and Control Costs

How to Get Ahead of Employer Health Care Costs to Effectively Manage Risk and Control Costs


Sponsored by The Partners Group

How can we look at an employee population and figure out not just who has cost a lot, but who has the capacity to cost a lot?  Once we identify the high risk members, what can we do to help prevent their health issues from escalating into the high-cost category? 

Solution:  Shifting from the Rearview to the Windshield View Perspective

With escalating health care costs, employers must arm themselves with the tools necessary to effectively manage health care risk and avoid significant costs.  As health care evolves, health care risk to employers becomes increasingly more and more complex, and in the health care world one of the most valuable strategies is to know your data and how to use it for tactical decision-making. Otherwise it's tough to manage what you can't measure. 

There are strategies and tactics to shift perspectives from being solely focused on the past, to focusing on what is coming down the pipeline in terms of your employee health plan costs. In other words, employers can shift from using the rearview mirror to using the windshield view with the ultimate end goal of putting data analytics tools combined with human management strategies in place to avert, mitigate, or manage the next high cost encounter. This is a different way of dealing with the challenge of understanding health plan costs and figuring out what to do about them. 

Traditionally the industry has been focused on historical data, i.e. what happened to cost trends. It’s important to understand where things have been from a renewal and a budget increase perspective. However to really get ahead of the cost curve, and to manage risk and costs, employers need to start looking through the windshield at what's coming ahead.  

There are so many opportunities to look at risk measures, and for the employer to take an appropriate yet more active role in encouraging the population to pursue higher levels of health awareness and accountability.  Nevertheless, an employer can only do so much to manage risk on their own, and a health plan can only do so much to manage risk on their own. Employers need to gain an understanding of what is going on with providers, including analyzing your health care data, doing PCP (preferred care provider) attributions, examining the patients that are seeing these docs, plus looking at activities such as ER and advanced imaging utilization efficiency. 

Whether you're an experienced, fully insured group with 200 employees or a 2,000-employee self-funded group, the Pareto Principle, otherwise known as the 80-20 rule, holds very true for employer health plan costs. This is relevant to groups of all sizes.…  

This takes health care which we typically look at as a large numbers problem, and it gives us a different perspective. It is really a small numbers problem because it's a relatively small number of people who drive the majority of the cost. For example…

When you consider the effect of the top 5% of claimants, it helps you make decisions and it helps you realize where you need to focus your resources. With this in mind and knowing that relatively few people drive the majority of costs with high turnover year over year, there are medical management tools and resources that are used in the industry today to help employers manage cost.  However, the one thing that all these currently used strategies have in common is that they're all reactive, and the cost of the risk has already materialized or is about to be incurred. This is where we have an opportunity to shift to the windshield view and take a more proactive stance, with the goal of preventing or at least better managing the next high-cost encounter.  

Watch this video for more information about the 80/20 rule

Once we've identified the high-risk individuals, there are strategies for getting people to take action. We not only want to make them aware of their situation, we want to actually engage them with the appropriate care at the appropriate time in order to mitigate some of these gaps in care and try to at least keep them from escalating into the high cost category.

Lastly, data surveillance is the sentinel. It is key to monitor your data for changes that could be unfavorable or costly.  You want to keep a watch out for events that explain changes and/or present an opportunity to avert even higher potential costs. 

Click for a video explanation on how wellness programs can help

Access a detailed whitepaper on this innovative process, and learn more about taking the first steps to successfully manage and control your healthcare risk and costs by contacting The Partners Group here.

For over 35 years The Partners Group has been serving the financial and insurance needs of employers, medical professionals, and successful individuals with services including employee benefits and business analytics consulting, retirement planning, investment services, commercial and individual insurance.