Becoming consumer-centric with payer analytics

Improving health outcomes, affordability, and member- centricity

Today’s health plans are facing a rapidly evolving environment that’s prompting them to reconsider their priorities and investments. One of the biggest changes is the seismic shift in the orientation of health plans toward individual consumers, which is the result of several broader trends:

• Innovation models from other industries: The data-driven approaches of consumer-focused companies (such as Amazon, Netflix, and Uber) have demonstrated to health plans that innovation is feasible and likely to expand their markets and impact.
• Growth in consumer purchasing responsibility: The increase in direct-to-consumer health insurance provides an essential business rationale for becoming closer to the individual needs and concerns of their members.
• New consumer expectations: Ubiquitous consumer-centric services and solutions have increased expectations for convenience, responsiveness, and simplicity.
• Increased understanding of the value of engagement: Health plans have recognized that many of the core challenges they face all require engaging individuals on their own terms, affecting the actions they take and the decisions they make.

Solving real-world problems with consumer analytics

Health plans that use advanced payer analytics and artificial intelligence to deeply understand individual consumer needs, interests, barriers, and motivators are better positioned to compete in the marketplace. Leading health plans have been able to harness the power of consumer analytics to derive value in several important areas, including growing and preserving revenue, containing medical costs, and reducing administrative costs.

Forward-thinking plans recognize that analytics on consumer interactions and behaviors can not only improve member experiences, but can also help them develop initiatives to positively influence consumer actions and decisions. These plans are also taking advantage of technological advances to more readily and securely ingest, integrate, and analyze diverse types and sources of data—often via scalable, cloud-based technologies.

Where are plans investing in analytics?

In 2017, the Deloitte Center for Health Solutions surveyed 45 analytics professionals at health plans to better understand the priorities and challenges of implementing analytics within a health insurance organization.

The two most common business goals driving analytics investments are highly consumer-focused. To address the first, improving member experience, health plans should diagnose current issues, understand and predict drivers of positive experience, tailor support to address key drivers of experience, assess the success of efforts to improve experience, and undertake other actions that leverage insights about and from consumers.

Improving medical costs and affordability will be partially enabled by efforts to identify high-need members and provide them with support for smart choices about their health and use of services. Other ways to increase efficiencies and profitability via consumer analytics insights include optimizing individual use of services, improving understanding of consumer interests in products, and driving sales through targeted marketing activities.

Plans that embrace the industry’s shift toward consumer empowerment and affordability by building new analytics capabilities can realize competitive advantage. Mining consumer analytics can help improve care experiences and outcomes; build deeper connections with members; and deliver value for employer, individual, and government purchasers. However, there are significant barriers to expanding consumer analytics capabilities that require a deliberate strategy and consistent execution over multiple years.

How different plans approach consumer analytics

To get a better sense of how different plans were approaching consumer analytics, we conducted an in-depth analysis of participant responses. And four distinct archetypes emerged, characterized by the level of adoption and strategic coordination of their consumer analytics initiatives.

The appropriate course of action for a health plan will depend on which archetype best describes it. An ideal approach for dabblers is to identify three or four high-priority use cases that can be overseen by business leaders who can champion adoption.

Skeptics need to focus on promoting organizational buy-in and encouraging demand for new payer analytics capabilities. Essential to this is having some high-profile successes that can be used to rally support.

For scattershots, achieving a shared understanding of consumers across the enterprise is critical. The biggest opportunities for these organizations can be realized by forming or realigning enterprise-level data and analytics structures and analytics operating models.

Finally, pack leaders should focus on how to use consumer analytics as a differentiator in the marketplace. They should use their deep capabilities to expand into areas such as consumer applications that leverage artificial intelligence approaches that connect disparate data to deliver new insights to business leaders.