Andy Ashta, Executive Director, Information Architecture, Health Care Service Corporation
Health care costs continue to rise and patients often find themselves navigating a complex world in order to get quality, cost-efficient care. It used to be that the only technology a patient needed was their health insurance card. Card in hand, they visited their doctor of choice and received care. Later, the patient received a paper explanation of their benefits, which indicated whether the claim was paid. Most claims were paid by the insurance company, and occasionally, the patient incurred a small out-of-pocket expense, which they learned about weeks after the visit.
Today, patients find themselves having to be active consumers of health care. Those small out-of-pocket expenses can become very large expenses for the unknowing consumers. Now, consumers need to know which providers are in-network, how much a procedure costs and what’s covered in order to get the best value. This is where technology plays a key role. Patients want more information at their fingertips, including information about providers, coverage, wellness tips and more. They expect that information to be delivered in an engaging and personalized way that takes into account their unique health care needs.
Harnessing the Right Technology
Technologies that supported consumers two decades ago cannot support them in the same way now. While individual fixes may help in the short-term, new solutions are needed to get the best quality care at the best price. This requires not only changing technology but also changing consumer behaviors—a challenging undertaking.
Technologies like artificial intelligence and machine learning that can collect and analyze large amounts of data in real time can more effectively help organizations understand what consumers need. While emerging technology will never replace human logic, it can work in tandem to find irregularities in care, more efficient treatments and ways to personalize the patient experience.
IT professionals must monitor new technologies with a strong bias toward how to improve the consumer experience
Health Care Service Corporation’s (HCSC) digital team works closely with customer advocates, who connect first-hand with members, to help provide the tools that prompt proactive care questions.
For example, a consumer calls to ask about their coverage for radiology. A customer advocate might direct the patient to the nearest in-network radiology facility and help them schedule an appointment. While they have them on the line, they can remind the patient to refill an existing prescription. Using advanced analytics and AI to gather and populate this data, the customer advocate can not only respond quickly to the consumer ask, they add value by anticipating future needs. Imagine that same experience delivered by an easy-to-use mobile application.
Aligning to the Business
Whether it be a personal or digital interaction, consumers expect a positive experience. IT professionals must monitor new technologies with a strong bias toward how to improve the consumer experience. However, consumer experience projects cannot become siloed.
Projects to improve the consumer experience can only succeed when business and technology strategies align. For example, as part of a broader effort to more seamlessly share data, HCSC uses application programming interfaces (API) with patients’ employers and the employers make relevant information available to their employees. APIs make it easier for developers to expose only certain information in a secure fashion while keeping patient information confidential.
If organizations don’t connect with the business strategy at the onset of new initiatives, they risk a stagnant consumer experience and may struggle to catch up to their growing expectations.
Enhancing Team Operations
Understanding consumer needs and expectations requires the support of the entire organization, which may lead to rearranging how teams are structured. This may involve pulling together different specialties, such as business experts, user experience designers and development teams. HCSC goes as far as co-locating multi-disciplined teams. They work in an iterative fashion, experimenting on how best to apply new technology to enhance the customer experience. While the team develops its technology capabilities, they simultaneously build trust and a shared sense of mission in meeting consumer needs.
Meeting and anticipating consumer expectations to connect digitally and beyond is a big and ongoing undertaking, but it is central to what IT professionals do. Organizations should strategically identify and introduce new technologies on a continuing basis, align the technology strategy to the business and redefine the development process to bring those tactics to fruition.
Many organizations have already been on this journey for several years and can see the positive outcomes of improved consumer satisfaction. However, the work is never complete. As the digital evolution continues, we can deploy more consumer-facing applications and advanced analytics to help improve the quality of consumer interaction and help them tackle their health care needs.