The following was first published on The TIBCO Blog.
It would be hard to find someone to argue against the idea that healthcare has enormous room for improvement. While other industries became process-focused, automated, analytical, mobile, social and event-enabled, healthcare focused its technology efforts on the latest diagnostic equipment, and on systems that facilitate billing and claim processing, but not on the technology that would make healthcare cheaper or better.
An insurance company that wants to compete in the coming changes, including accountable care, bundled payments, and selling directly to consumers and through Health Insurance Exchanges must come to the table with the technology that enables competition. It will be a wide-open landscape for the payers who make the investment in process, analytics, pricing, cloud, social and mobile.
The changes that are coming, regardless of the outcome of the Supreme Court decision, will require development of new processes throughout organizations. Just as the rest of the world moved to business process management systems, payers will need to develop business process governance and deployment capabilities. Death from 1,000 Visios is an avoidable fate with products that manage both manual and automated process. Add business events capabilities to the mix, and organizations have the ability to identify and quantify the impact of events on operational processes, providing easy opportunities for agility.
Analytics and pricing
With a greater number of people coming under coverage in the coming years, old models for coverage will quickly be insufficient. Analytics capabilities that allow for better population segmentation and pricing will need to be developed. Healthcare needs to develop a Big Data capability that answers this call in landscape of traditional payments, accountable care or bundled payments. Competition will come down to service and price in combination, putting pressures on payers to create dynamic models that allow for fast response to changing conditions. Getting feedback from a model’s performance means having excellent visualization capabilities that allow for in-the-moment decision making and not reactions to outcomes long after the fact.
Find, retain and recapture
Consumers increasingly seek more choice and have continually higher expectations for customer service. Fairly or unfairly, the health insurance industry is often viewed from the outside as the place that denies coverage. To move from a captive customer model to one that is responsive to market needs, able to increase loyalty and regain lost customers will rise to the top of the industry. Doing this will require processes, analytics, loyalty and business event technology that isn’t currently in place in healthcare. Interrupting the path to disengagement is far cheaper than trying to regain business once lost, and will require a new way to look at customers and the key events that gain and maintain their loyalty.
For payers, a significant portion of the battle for hearts and minds will be played out in ways much different than phone calls and long holds. Being a customer of an insurance provider needs to be about prevention, wellness, and health monitoring that creates a sense of community, similar to what’s done in the hospitality industry. The infrastructure required to tailor messages and proactively respond to life events, illnesses and accidents can be a significant source of loyalty and cost reduction at the same time.
On the go
Rapid increase in the use of mobile platforms means that the best way to move information to or from a customer will be through mobile technology. Mobile apps aren’t that complicated to build and maintain, but are far more powerful built on an infrastructure that puts data in motion where the app can find and act on it. The cloud forms an important way to flexibly provision computing and storage to satisfy these new needs. Rather than a huge infrastructure investment, smart companies will take full advantage of Platform as a Service to meet their needs.
We’re at the crossroads of disruption in healthcare. Healthcare requires solutions that are flexible, scalable and easy to integrate into legacy databases and applications. The days of monolithic and healthcare-specific applications are coming to a close with the opening of the business model to greater competition and focus on cost reduction and better outcomes. Will you be ready?
Stop by and say ‘hello’ at our booth at AHIP today.