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Article
19 minute read 20 May 2021
FUTURE-PROOFING THE BUSINESS
BUILDING A SUPERIOR EXPERIENCE FOR HEALTH PLAN CUSTOMERS THROUGH DIGITAL
TRANSFORMATION
BILL PRESTON
United States
×
BILL PRESTON
PRINCIPAL | DELOITTE CONSULTING LLP
Bill Preston is the Deloitte Consulting LLP lead for Health Plan Margin
Improvement. A principal in Deloitte’s Health Care and Life Sciences practice,
Bill has led several transformational programs within Health Plans and PBM
operations including rapid cost reduction, executive and client financial
reporting, and establishing strategic outsourcing partnerships for Deloitte
clients. Other engagements are conducting a service operations assessment of a
national PBM and enhancing the Specialty Pharmacy operational.
* bipreston@deloitte.com
* +1 404 631 3723
*
MATTHEW KAYE
United States
×
MATTHEW KAYE
MANAGING DIRECTOR | DELOITTE HEALTH CARE STRATEGY & INNOVATION
Matt is a managing director in Deloitte’s Health Care Strategy & Innovation
practice, leads Deloitte's Digital Transformation offering in Health Care, and
is the Hybrid Market Offering Leader for ConvergeHealth Connect™ for Health Care
products. Matt focuses on customer and digital strategy across the health care
ecosystem. He has 20 years of experience developing customer experience,
analytics, and digital strategies, and designing the products, capabilities, and
technologies required to execute them. In January 2013, Deloitte acquired
Monitor Group, where Matt was an Associate Partner. Prior to joining Monitor
Group, Matt spent five years at GE Capital, where he held various finance and
pricing roles in the US and Asia.
* mkaye@deloitte.com
* +1 212 829 6224
*
JIMMY JOSEPH
United States
×
JIMMY JOSEPH
CYBER & STRATEGIC RISK, MANAGING DIRECTOR | DELOITTE RISK & FINANCIAL ADVISORY
Jimmy Joseph is a managing director within Deloitte & Touche LLP’s Cyber &
Strategic Risk practice and leads Deloitte's health care cybersecurity operating
portfolio. He also leads Deloitte's cyber services related to Microsoft
platforms, such as Azure. He has more than 20 years of experience in
Cybersecurity and has focused exclusively in health care for the past 10+ years.
His experience includes transforming enterprise cybersecurity programs including
strategy, architecture, implementation and operate across people, process,
governance and technology domains. He is a well-rounded cybersecurity
professional with experience in information risk management, data protection,
cloud security, security operations, regulatory compliance (NIST-CSF, HIPAA,
HITECH, HITRUST, ISO 27002:2005, PCI DSS), and executive/board engagement. Jimmy
is a trusted advisor to several senior executives (CIO, CTO, CRO, and CISO) in
the health care space.
* jijoseph@deloitte.com
* +1 617 771 7556
*
NATASHA ELSNER
United States
×
NATASHA ELSNER
MARKET INSIGHTS MANAGER | DELOITTE SERVICES LP
Natasha, Deloitte Services LP, is a research manager with the Deloitte Center
for Health Solutions. She has spent more than 10 years in market research
serving health care clients. With extensive experience in research methodology
and data analysis, Natasha conducts cross-sector research at the Center. Natasha
holds a master’s degree in survey research and methodology.
* nelsner@deloitte.com
* +1 215 282 1087
HEMNABH VARIA
India
×
HEMNABH VARIA
ASSISTANT MANAGER
Hemnabh Varia is an assistant manager with Deloitte Services India Pvt Ltd,
affiliated with the Deloitte Center for Health Solutions. He has over 8 years of
experience in market research, competitive intelligence, financial analysis, and
research report writing. Varia holds a master’s degree in business
administration from Mumbai University.
* hvaria@deloitte.com
* +1 615 209 6741
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As health plans move into the future of health, they should live up to the
standards of other industries that have moved toward customer centricity through
digital transformation, building on a foundation of transparency,
interoperability, and trust.
*
*
*
*
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FUTURE-PROOFING THE BUSINESS
by
* Bill Preston
* Matthew Kaye
* Natasha Elsner
* Hemnabh Varia
* Jimmy Joseph
*
*
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EXECUTIVE SUMMARY
For health plans, staying competitive as we move to a customer-centric Future of
HealthTM will effectively mean delivering a seamless, personalized, and secure
experience that exceeds customer expectations. Health care organizations will no
longer get a pass simply because “it’s complicated”; they should live up to the
same standards as other industries. A better customer experience can be built on
the foundation of transparency, interoperability, and trust. Health plans that
can succeed in this future are those that recognize the need to transform their
business from managing enrollment and pooling risk to taking care of members’
health and well-being over their lifetime.
What progress are health plans making in this transformation? A survey of 35
technology leaders at health plans and 30–60-minute interviews with 10
technology executives showed that the headway is slow and the challenges are
many.
Learn more
* Explore the Health care collection
* Learn about Deloitte’s services
* Go straight to smart. Get the Deloitte Insights app
Organizations’ understanding of what it means to be digital has evolved from an
efficiency play to enhancing the customer experience as the main goal today.
Fifty-seven percent of survey respondents seek better customer service and
engagement as the No. 1 outcome. While the member is the most important
customer, health plans think of caregivers, employers, brokers, their own
employees, and government purchasers as customers too.
Realizing this vision of superior customer experience through digital
transformation calls for a different set of skills from technology professionals
and executives. Respondents call it systems thinking, engineering
mindset, or end-to-end planning. It involves understanding the whole system, the
overall goals, its various subsystems, and the recurring patterns in the
relationships between the subsystems. To achieve systems thinking, technology
teams should work closely with the business and bring in experts with
human-centered design and user experience, whereas technology leaders should be
part of strategy planning and execution.
Modernization progress of customer-facing platforms is slower than other core
platforms. We asked respondents about modernization progress of five technology
platforms (clinical, core admin, analytics, engagement, and customer service).
Only two (of 45 respondents in the survey and interviews) said they have
completed modernization of a single platform. The majority are in process or
plan to modernize in the next one to two years. Engagement and customer service
platforms see the least progress: 57% and 45% of respondents, respectively, are
in process or plan to modernize within one to two years. How organizations
approach platform modernization is informed by their existing infrastructure,
previous technology investments, vision, and growth strategy.
Shift left on cyber. The survey respondents identified cyber and information
security as the number two investment priority after business intelligence.
However, interviewed leaders warned it could be expensive to correct
cyber-related mistakes, particularly ones having to do with cloud configuration.
Baking in cybersecurity in DevOps from the outset can make for a more efficient
and resilient process.
Our respondents also spoke of challenges. Two-thirds identify lack of requisite
expertise (69%), such as cloud engineering and software architecture, and
incremental investment approach (66%) as their main challenges. Half say
disparate systems and businesses from M&A activity (54%) and the lack of defined
vision (49%) have challenged their digital transformation agenda.
Our view is that while platform modernization is important, health plans at
different stages of digital transformation have an opportunity for quick wins in
three areas that can help advance their digital agenda: customer engagement,
analytics, and cyber. Below are a few examples.
• Add texting to omnichannel engagement
• Create self-service workflow to help customers with easy questions (e.g.,
benefits inquiries or claims status inquiries)
• Take advantage of analytics to improve care gap closures and social service
referrals, or to create personalized network steerage suggestions
• Enhance identity and access management
Digital transformation is about future-proofing the business. In Deloitte’s
vision for the Future of Health, companies that can create a delightful customer
experience, invest in their health, and earn their trust will win. The time is
now for health plans to seize this opportunity and execute a robust digital
transformation strategy.
RESEARCH FINDINGS
ABOUT THE STUDY
In February 2021, the Deloitte Center for Health Solutions surveyed 35
technology leaders (including chief technology officers, chief information
officers, chief digital officers, and chief analytics officers) from health
plans with a minimum of 500,000 lives. The survey included questions about
investments in technologies and broader organizational strategies to understand
their priorities and vision. All 35 responding organizations participate in
government programs and 31 sell commercial health insurance products.
In addition, in February–April, 2021, we conducted 10 in-depth qualitative
interviews, 30–60 minutes each, with technology executives from regional and
national health plans to understand the approaches they are taking toward
modernization of their legacy platforms and goals they hope to achieve in the
short and long term.
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WHAT DOES DIGITAL TRANSFORMATION MEAN?
Digital transformation is a journey, not a destination
Several organizations told us their vision for digital transformation has
evolved over time. Initially, it was mostly an efficiency play, whereas now it
is about customer experience. As our respondents put it, digital transformation
is a means of building a connected ecosystem of members, providers, and internal
stakeholders to provide value-centric services, enhance member relationship, and
improve collaboration across the value chain while leveraging multichannel
opportunities.
“Early on, it was about basic process automation. There was always a strong
desire to digitize and automate workflow, which was done in silos. Over time,
the focus shifted to how we create seamless interactions across silos that
otherwise create handoffs.”—Director, digital planning
To thrive in the future and head off new competition, health plans recognize the
need to significantly modernize their core platforms and transform their
business so that they can meet customers’ evolving demands.
“Every industry has gone through democratization, transformation, and
transparency, whether it’s a seat in the travel industry or a product in retail.
But when you look at health care, the transparency, availability, and
convenience don’t exist, and the underlying software platforms are holding it
back.” —SVP and chief digital officer
Respondents admit that health care lags other industries, even heavily regulated
and conservative ones like finance and property and casualty insurance. Most of
the survey respondents say they are in the early stages of digital
transformation: 77% reported they need three to five years or even more to fully
implement their digital transformation plans. Respondents recognize that digital
transformation can never be declared complete because new investment
opportunities continue to arise. Even organizations that date the start of their
digital transformation programs back to the early 2000s or 2010 say they have a
lot left to do.
WHAT OUTCOMES DO HEALTH PLANS WANT TO ACHIEVE THROUGH DIGITAL TRANSFORMATION?
SEAMLESS CUSTOMER EXPERIENCE IS THE END GAME
Experts we interviewed say the No. 1 outcome they try to achieve through digital
transformation is to improve the customer experience. They employ interactive
capabilities, online tools, and apps to create a seamless information-driven
end-to-end experience—whether it’s to understand and navigate benefits, access
care, or receive health advice. And they are beginning to leverage artificial
intelligence (AI) and analytics to guide the member to the next best action.
In the survey, 34% of respondents say better customer service and engagement is
the No. 1 outcome they expect as a result of digital transformation; for 57%, it
is one of their top three outcomes (figure 1). Other key benefits include
reduced regulatory and compliance risk (57%) and increased agility and
scalability around technology (54%). We heard that sometimes regulatory
requirements can create opportunities, for instance to fund an initiative (like
interoperability, price transparency, or automated prior authorizations) that
wouldn’t be an immediate priority without the regulation. And although agility
and scalability around technology isn’t a business goal in and of itself, we
heard repeatedly that this is essential for doing business. In the words of one
executive, “Companies that aren't in the software industry need to start
behaving like software companies in terms of how they push solutions and meld
the technology with the business.”
While the member is the highest priority customer, health plans we interviewed
think of caregivers, their own employees, employers, brokers, and government
purchasers as important customers too. However, it is impossible to prioritize
everything, and at many organizations, these other customers are taking a back
seat for now. The survey results echo this: Data sharing and collaboration with
providers (49%) is the fourth-highest ranked desired outcome of digital
transformation, better service of employers and brokers is much lower (14%), and
the ability to leverage alternative workforce models is in between (31%).
Companies we spoke with prioritize digital initiatives by line of business,
geographic market, and as a response to COVID-19 (e.g., digital and virtual
health).
It appears that digital transformation is on the rise vis-à-vis other enterprise
priorities. In a recent study of health plan CFOs, finance executives reported
that over the past year their organizations increased capital investments in
digital (AI, RPA, cloud) and core business technologies (ERP, clinical,
operational), whereas investments in ventures and other businesses and in new
building assets decreased.1
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IMMEDIATE AREAS OF FOCUS
1. Better campaign management
Health plans told us they are making progress toward better customer experience
by improving how they communicate.
One interviewed executive told us their organization created a “contact
preference”capability to obtain permission and identify member preferences for
communications, which in turn enabled it to design a campaign management system
that segments members and matches the communications to their preferences and
needs, such as preferred language, channel (text, email, phone, mail, app), and
frequency.
2. Reducing the burden on the member
Health insurance products are difficult to understand, use, and shop for, and
health plans are designing processes that make it easier for customers to do
these things.
One health plan created a context-driven device-appropriate workflow for
Medicare enrollment that presents questions and next steps based on prior
answers and existing information. For instance, an existing member transitioning
from a group plan to an individual Medicare Advantage plan is not asked to enter
information that the plan already has (such as demographics or current
medications). And while a prospective member will be asked for more information
than an existing one, the redesigned shopping and enrollment process is far less
confusing, and includes tips, tricks, and FAQs.
3. Reducing the burden on employees
Often, contact center representatives have to navigate multiple applications
just to get the information they need to do their job. Health plans employ
digital tools to pull information in real time from multiple underlying core
systems around enrollment, benefits, claims, care management, and pharmacy,
creating a far smoother experience for representatives serving members and
providers.
4. Making care management more efficient
One technology leader described a digital care management program through an
external vendor that allowed them to engage more effectively with members who
are prediabetic, newly diagnosed diabetics, and those who have had diabetes for
some time. This program significantly increased their ability to reach more
members and allowed them to free up care management nurses to engage more
frequently and in real time with these members. The organization is now planning
to expand this program into other chronic conditions.
LONGER-TERM GOALS
1. Member retention
Each time a member switches to a competitor, it costs the health plan money to
recruit a new member to replace him or her. For this reason, investing in a
positive customer experience today should pay dividends in member retention in
the future. Additionally, new sensing tools based on advanced analytics and AI
can generate actionable intelligence to prevent disenrollment through timely
service recovery or other efforts. But the most valuable currency for member
retention is trust—health plans should prove to their members that they
genuinely care about them—and health insurance as an industry is starting from a
low level of trust.2
“It all comes down to trust, getting consumers to trust you explicitly. We can
build all the services but to really do it, customers need to believe you look
out for them, not yourself. Health plans are always the butt of the blame for
everything wrong with health care.” —CTO
2. Improved health care outcomes, at scale
Interviewed executives spoke of using advanced digital tools such as machine
learning and AI to create next best actions by identifying trigger events (such
as medication errors, malnutrition, hospital-acquired infection) or “forks” in
the member journey that can set them down one path or another. These insights
can help guide members toward a path or next best action that would optimize the
outcomes they aim for. These tools will build on existing risk stratification
models and integrate members’ devices (Fitbits, smartphones, smart speakers),
add other data, and train these models to generate and customize next best
actions. Data can be internal (claims, care management, prescription history)
and external (community-based organizations, customer apps, search histories),
and the more data is collected, the smarter the model gets, leading to a greater
impact for more members.
Additionally, organizations are building the data and analytics infrastructure
that will support value-based contracting with providers (through data sharing
and decision support), with the goal to improve population health. Regulatory
mandates on interoperability are helping these efforts.
3. Increased operational efficiency
Using workflow automation, health plans can create self-service platforms for
members and providers. This could alleviate the need for staff to attend to
routine things like answering basic benefit questions. Instead, they could be
redeployed toward higher-value activities like supporting members with complex
care needs around disease education, social needs, or care navigation (e.g.,
coordinating second opinions or travel arrangements to a clinical center of
excellence).
WHAT SKILLS DO TECHNOLOGY PROFESSIONALS AND EXECUTIVES NEED?
It is not just about technology
Technology skills alone are not enough to ensure success of digital
transformation. Digital transformation requires strong understanding of the
business, technology, and systems thinking (we also heard the terms engineering
mindset and end-to-end planning to describe this concept). One of our
respondents said that systems thinking used to be a classic IT construct prior
to the 1970s and 1980s. It requires understanding the whole system
(organization), the overall goals, its various subsystems, and the recurring
patterns in the relationships between the subsystems. By focusing on the entire
system, one can find solutions that address as many problems as possible in the
system and remove friction between different parts.
“IT teams have to have a systems view end-to-end of how each piece plays into
everything else. Without that, each piece creates its own entry and exit
criteria that even in combination create a value chain that’s too heavy and
administrative. End-to-end perspective ensures they can understand the security
and quality controls, the nonfunctional requirements of the delivery platform or
process that ensure the integrity of the process. So yes, it’s a new way for
people to have to think in IT, but it comes from an old set of skills and
alternative disciplines.” —SVP and CTO
To achieve systems thinking, technology teams should work closely with the
business, and technology leaders should be part of strategy planning and
execution. Respondents gave advice on where to look for these skills: For
instance, people with Six Sigma backgrounds can see, analyze, and break down
processes, and apply systems thinking; and human-centered design and user
experience experts are important because they understand the customer point of
view and user experience.
Additionally, interviewees said that the role of technology leaders should be
more defined, and they should be empowered to take strategic decisions and have
a say in the budget.
HOW DO ORGANIZATIONS PRIORITIZE LEGACY PLATFORM MODERNIZATION?
Health plans recognize the need to retool or transform their core technologies
and processes to reduce costs, improve the medical loss ratio, and position for
increased adoption of digital technologies. With an outdated infrastructure, it
can become increasingly difficult to take full advantage of new digital tools
and truly improve customer experience.
Approaches to platform modernization vary. Only two of our respondents across
the survey and the interviews have completed modernization of a single
technology platform. The majority are in process or plan to modernize in the
next one to two years. Survey respondents say they have made the most progress
with clinical platforms; this includes care management, utilization management,
and medical policy (figure 2). And they report the least progress with
engagement and customer service platforms. Our research suggests that how
organizations approach platform modernization is informed by their existing
infrastructure, previous technology investments, vision, and growth strategy.
Below we describe several approaches we observed.
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Case study 1. Building the digital foundation requires an overhaul. At one
organization, an antiquated core platform of 30 years ingrained in all aspects
of the work was restricting growth and ability to scale. Consider a member phone
call where a contact center representative has to open eight or 10 applications
to have all the necessary information on the member.
With the new system, reps will have all information in one place—enrollment,
eligibility, claims, care and utilization management—which will help them
connect benefits around medical, dental, vision, and pharmacy. Despite a system
stabilization period that will be required when multiple platforms go live at
about the same time, the tech executive expects to see benefits within a year.
As a next step, the organization is defining a digital member journey. One
element in that journey is an AI-driven capability to prompt the member toward
next best actions for her health, building upon her profile, clinical and claims
history, social determinants of health, and other internal and external data.
“We started with the core. That core is very hardwired and modularized, and if
you try to take out one module you’ve got to take out the other module, and as
you lift that one out, there is something else we have to address. Daunting
doesn’t even begin to describe it!” —Vice president, IT & CTO
Case study 2. Complete overhaul is not the answer. Organizations decide whether
to retrofit or replace based on which drives the most value. Some can extract
value from existing platforms, especially those that were updated in the past
couple of years.
One organization saw the greatest value in modernizing its data and analytics
platform, which supercharged its data collection and integration, analytics, and
recommended actions.
All digital data (in notes and in forms) is fed into a natural language
processing engine and those insights enhance risk stratifications algorithms and
estimates of member likelihood to engage in care management programs. Data
integration tools convert this and other data into formats that their legacy
care management and administrative systems can recognize, and those legacy
systems create the workflow for customer service and care management staff to
serve members in new ways. For instance, customer service reps can now close
gaps in care by helping members schedule a wellness visit or by transferring the
call to a telehealth specialist, and care management nurses can refer members to
specific community resources (based on member social service need and
geography).
“We modernized our data and analytics platform because at the end of the day,
the data and analytics is really what’s going to drive a lot of the downstream
workflow in the legacy systems that are operational in nature. Do we always get
to do what we want because maybe the legacy system has limitations? No, we
don’t. But as the API technology evolves, it will allow us to go a little bit
further.” —SVP, chief data officer
Case study 3. Connecting the silos left from previous digital initiatives. One
provider-sponsored health plan began its digital initiatives in the 2000s; at
that time, it aimed to improve the efficiency of operations at a functional
level. Considerable care was given to preserving the firewalls between the care
delivery and health insurance side of the business. However, this resulted in a
disjointed experience for the member and in low adoption of digital tools.
Once the organization applied the customer lens, it became clear that they
needed to break down functional silos, and cross-functional teams from both
sides of the business needed to sit together and talk to each other not “my
department vs. your department” but from a member standpoint.
This in turn created a need for a different governance approach. They assigned
champions from senior ranks to lead and be accountable for the effort, with
dedicated teams supporting them. And approvals of large digital transformation
initiatives had to take place above the business unit and go all the way to the
board of directors.
“There was a feeling that we don’t want the health plan to be involved in care
delivery and vice versa. We built nice digital things on the care delivery side
and on the health plan side that were related, but the pieces did not connect
well, and the consumer was mad. Now, the leadership felt that their investment
is not paying off because consumers are not adopting.” —Director, digital
planning
Case study 4. Acquisitive growth calls for strategic integration. For an
organization that grows by acquisitions, the technology challenge is having to
constantly bolt on new systems, data sources, people, standards, and data
centers. If the goal is to extract the scale premium from M&A, the technology
should focus on integration.
This organization uses two approaches. The direct-to-digital approach is to
layer on top of the integration effort the movement toward the digital solution
that the organization wants, which requires completing a two-step integration in
one step. For instance, an on-premises email system of an acquired company is
allowed to remain until the entire organization moves to a new system: This
skips the step of moving from one legacy system to another as an interim
integration. Complex legacy assets, on the other hand, require functional
migrations: The provider experience is moved to the provider portal and member
data to the member system. For government programs, functional migrations can
take years because of regulatory requirements around data integrity and data
preservation.
“We’ve learned that integrating companies requiring big bang membership moves is
really dangerous: The configuration of benefits, the links to providers and
systems are so deeply embedded that integration of assets through functional
migration is more effective than direct-to-digital.” —SVP and CTO
CYBERSECURITY IS KEY TO CUSTOMER TRUST
Cyber and information security did not rise to the very top as a technology
investment priority in the survey; it was number two, after business
intelligence (figure 3). But interviewed respondents warned that it can be
expensive to undo or correct cyber-related mistakes. Several said cloud
architecture can be a cybersecurity landmine, especially when organizations
operate in or integrate multiple cloud systems. When security-related issues
arising from multicloud environments that don’t “play well with each other”
become visible to customers, organizations can lose trust that would be
difficult to restore.
“Even a hint at information security gaps is a showstopper. People will abandon
whatever they are doing if things are not behaving in a way they have seen on
Amazon or another digital site.” —Director, digital planning
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The 2020 IBM study on data breaches suggests that these anecdotes from our
respondents may be indicative of a trend: Stolen or compromised credentials and
cloud misconfigurations were the most common causes of security breaches,
accounting for nearly 40% of malicious incidents,and the average cost of data
breach in health care was US$7.13 million, the highest of all industries.3
SHIFT LEFT ON CYBER: CULTIVATING A DEVSECOPS MINDSET
In our client experience across industries, we have observed that even as
technology organizations began embracing agile development, many continue to
approach security in the same incremental, siloed way they did with waterfall.
And in many DevOps pipelines, security is still treated as a bolt-on rather than
a design feature. We recommend a shift-left security approach, which gets
companies closer to DevSecOps, an evolution of DevOps. DevSecOps enables
companies to automate good cybersecurity practices into the toolchain and use
them consistently. The DevSecOps trend is more of a mindset than a formal set of
rules and tools, and systems thinking is at its foundation.4
“The move from on-premise data centers to cloud for a traditional health care
player is a lot more complicated than people think if you’re paying attention to
security. The first time you go into AWS, or try Google cloud, or the first time
you try Oracle cloud, there’s an enormous amount to get right: setup and
institutional knowledge, monitoring, security, performance, and everything else.
Because while each of those clouds sounds similar, their actual operations are
very distinct and different. You have to think systems thinking end-to-end, you
have to think engineering, and when you do, really really evaluate those
things.” —SVP and CTO
WHAT ARE THE CHALLENGES?
Expertise and commitment
In the survey, two-thirds of respondents said lack of human resources with
requisite expertise (69%) and incremental investment approach (66%) are their
main challenges. Half of respondents said disparate systems and businesses from
M&A (54%) and lack of defined vision (49%) have challenged their digital
transformation strategy (figure 4). In interviews we heard that technical
expertise—such as cloud engineering and software architecture, or even cyber,
data, and analytics—are easier to find than experts with institutional knowledge
capable of systems thinking.
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NO-REGRET MOVES FOR ANY STAGE OF DIGITAL TRANSFORMATION
Based on this research and our client work, improving customer experience
through digital transformation is not contingent on the status of platform
modernization or overall digital maturity. Health plans at different stages have
an opportunity to advance their digital journeys and achieve quick wins in at
least three areas: customer engagement, analytics, and cyber. Consider these
examples:
• Add text messaging (such as SMS) to omnichannel engagement. Customers
increasingly favor text communications over voice. These days, a texting option
can be a quick and inexpensive addition to a health plan’s customer service and
care management platforms.
• Self-service workflow can help customers get easy questions answered or steps
completed (e.g., benefits inquiry or claims status). This not only improves
their experience but also reduces workload for customer-facing staff. Consider
digital document upload for out-of-network claims or electronic submission of
prior-authorization requests and appeals.
• Analytics can raise customer relations or care management to a new level. In
case study 2, we illustrated how one health plan used analytics to improve care
gap closures and social service referrals. Other applications may involve
personalized network steerage suggestions (imaging or labs) for members with a
propensity to seek care out of network.
• Enhance identity and access management. A recent consumer survey showed 55% of
consumers have stopped using a website because the login process was too complex
and 92% of users will leave a website instead of recovering or resetting their
login credentials.5 Managing access and identities is an essential business
enablement function that touches on operational efficiency, compliance, and
cyber risk. At the same time, a well-executed, frictionless, authentication
process can improve member experience. It assures the member that their
information is secure without leaving them frustrated or locked out.
CONCLUSION
Digital transformation is about future-proofing the business. In Deloitte’s
vision for the Future of Health, customers will exercise agency, engagement, and
control over most decisions about their health and their health data, and there
will be greater focus on preserving health and well-being. Companies that can
create a delightful customer experience, invest in their health, and earn their
trust can win in this future. While health plans have different digital
transformation strategies and are at different stages of maturity, they all
recognize the time is now to seize this opportunity.
LET’S MAKE THIS WORK.
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LET’S MAKE THIS WORK.
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END NOTES
1. Wendy Gerhardt and Maulesh Shukla, Building resilience during the COVID-19
pandemic and beyond: How health care CFOs are navigating with an eye on the
future, Deloitte Insights, September 9, 2020. View in Article
2. David Betts, Leslie Korenda, and Shane Giuliani, Are consumers already
living the future of health?: Key trends in agency, virtual health, remote
monitoring, and data-sharing, Deloitte Insights, August 13, 2020.View in
Article
3. IBM, IBM report: Compromised employee accounts led to most expensive data
breaches over past year, July 29, 2020; IBM, Cost of a data breach report
2020, 2020.View in Article
4. Vikram Kunchala et al., DevSecOps and the cyber imperative: Elevating,
embedding, and evolving your risk response, Deloitte Insights, January 16,
2019.View in Article
5. Transmit Security, The impact of passwords on your business, accessed April
25, 2021.
View in Article
ACKNOWLEDGMENTS
Project team: Wendy Gerhardt provided oversight to the project and helped
interpret the findings for the paper. Apoorva Singh assisted in interpreting the
survey data, transcribing, and analyzing interview findings. We thank Dave Biel
for setting the overall direction of this research.
Acknowledgments: The authors would like to thank Leslie Read, Prayas Malhotra,
Vishal Iyengar, Deepak Gulati, Mark Lockwood, Chris Shudes, Abhishek Shukla,
David Geisinger, Alison Hagan, Kristin Klettke, Sujay Subramaniam, Phuong
Lecong, Danielle Pfeiffer, Paul Lambdin, David Kirk, Derek Hamilton, Lucia
Guidice, Sarah Heddleston, Ramani Moses, Sarah Thomas, Laura DeSimio, and the
many others who contributed to the success of this project.
This study would not have been possible without our research participants who
graciously agreed to participate in the interviews. They were generous with
their time and insights.
Cover image by: Ryan Olbrysh
TOPICS IN THIS ARTICLE
* Health Care ,
* Digital Transformation,
* Life Sciences & Health Care,
* Health Care Providers
DELOITTE’S LIFE SCIENCES AND HEALTH CARE CONSULTING SERVICES
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Principal | Deloitte Consulting LLP
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(Chinese)cn,CN,china,China,PRC,pcr,中,中國,香,香港,澳,澳門,chn,CHN,Zhongguo,zhongguo
* China (English)China
(English)cn,CN,china,China,PRC,pcr,中,中國,香,香港,澳,澳門,chn,CHN,Zhongguo,zhongguo
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* Country_af (Français)Country_af (French)
* Country_dx (English)Country_dx (English)
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* Country_mr (English)Country_mr (English)
* Country_sd (English)Country_sd (English)
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* Egypt (English)Egypt (English)EG, eg
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