Introduction
In the rapidly evolving landscape of healthcare, digital engagement and identity management have emerged as critical components for payer success. Today, we explore the importance of these elements and their transformative potential in driving efficiency, reducing costs, and delivering exceptional experiences for both members and providers.
Importance and relevance
Digital engagement, often referred to as the total experience, is the linchpin for enhancing retention rates and optimizing costs in healthcare. Despite significant investments in care delivery and additional systems, payers have yet to achieve the desired financial gains and are struggling to replicate the consumer-grade experiences seen in the retail industry.
This is harder now
Competitive shifts
Payers face intensifying competitive pressures from retail giants like Amazon, Walgreens, and Walmart, which are redefining healthcare with personalized care and consumer-grade experiences. Additionally, the rise of “payviders”—where payers are moving closer to care delivery through acquisitions and provider affiliations—underscores the need for strategic investments in care delivery.
Care delivery investments are successful when the consumers who use your owned providers report a higher NPS, score more highly on health outcome surveys and have a lower medical loss ratio than those served by conventionally contracted provider networks (From Gartner).
Consumer engagement is a top business priority for Payers as it can improve care costs and member experiences. Since payers must retain membership and lower costs because of their financial structures.
Regulation
Regulatory mandates, such as the Consolidated Appropriations Act of 2021 and the Transparency in Coverage rule, further emphasize the importance of accurate and up-to-date provider data. Consolidated Appropriations Act of 2021 which includes the “No Surprises Act” which eliminates surprise medical bills for consumers to help them make the best care decisions. As part of this mandate, provider directory guidelines began in 2022. Payers are feeling the push with other regulations such as the Transparency in Coverage rule, the Interoperability, and Patient Access rule, and Improving Seniors’ timely access to Care Act of 2021 all require accurate and up-to-date provider data to members.
Consumer demand
To stay ahead in today’s healthcare landscape, payers must leverage advanced analytics to drive sophisticated member and provider experiences. However, the effectiveness of these strategies hinges on the accuracy, completeness, accessibility, and utility of data.
Why identity is crucial
Identity data management is indispensable for delivering total experience initiatives for members and providers. Payers rely on accurate member, provider, and organizational data to deliver personalized health tools, streamline online scheduling, foster flexible networks with virtual care options, and improve care coordination. Demographic provider data further enhances member value by simplifying activities such as care advocacy and prior authorizations.
Accurate member, provider, and organizational data enable:
- Personalized and relevant health tools along the care journey.
- Easier online scheduling.
- Flexible, inclusive networks with virtual care options.
- Improved care coordination, including prior authorizations.
- Utilizing demographic provider data for care advocacy, medical shopping, and prior authorization activities, enhancing member value.
Conclusion
Digital engagement and identity management are paramount for payer success in today’s competitive healthcare landscape. By embracing these elements, payers can unlock transformative opportunities to enhance member experiences, drive efficiency, and reduce costs. However, success hinges on implementing robust identity data management solutions that connect disparate systems, accurately identify individuals, enrich data, and seamlessly activate downstream systems.
As the healthcare ecosystem continues to evolve, payers must embrace identity data management as a strategic imperative to drive meaningful outcomes for members, providers, and the organization.
Join us in unlocking success in healthcare through the transformative power of digital engagement and identity management. Together, we can pave the way for a brighter, more efficient, and patient-centric future.
Let’s navigate this journey together, leveraging the power of identity to drive transformative change and deliver exceptional experiences in healthcare.
Click here to learn more about how Verato can help you improve digital engagement.
