How Healthcare Payers Can Take Action to Compete in Today’s Digital World

“Digital” is such a ubiquitous element of our daily lives—so much so that it’s difficult to remember how revolutionary digital modes of connecting with people, analyzing and sharing information, managing life and work, and creating experiences really are. 

The healthcare industry provides a stark reminder of both sides of that transformation, where monolithic operating models and outdated tools and systems persist alongside some of the latest technologies and most nimble practices. That’s seen most acutely in the health insurance space, where the digital revolution has been gradually unfolding for years. 

But we’re reaching an inflection point—and if traditional payers (health plans, dental plans, and even specialty benefit administrators) want to stay competitive, now’s the time to act. 

A recent survey revealed that 93% of payers who have made digital investments noted significant membership increases, with 73% indicating a decrease in membership turnover. These investments—in everything from apps to provider portals to automation of mundane processes—also boost member engagement and retention, increase employee satisfaction, reduce costs, and deliver better health outcomes. 

For those that have long struggled with digital transformation, that will mean digging themselves out of old code and fragile legacy applications—all while keeping the business running and not disrupting customers. 

It will also mean understanding that change is difficult—the human aspect of transformation cannot be overlooked or downplayed. Grasping all of this and putting it into practice is the difference between sustaining a winning position and taking one-and-done shots in the dark. 
 
Though it may sound daunting, true change is possible—and attainable—and the benefits payers will reap are well worth the time and resources. We’ve seen it happen firsthand, both with health plans and dental plan organizations; over the years, we’ve helped support and guide complex transformations all the way from inception to realization and maintenance. 

It’s on the strength of this deep experience that we’ve assembled seven guiding principles to help you understand what it takes to build a digital business capable of leading in today’s world.   

7 steps to building a digital healthcare payer organization 

1. Beautify and optimize internal apps 

Younger employees—and digital natives, in particular—grew up using digital applications like Facebook and Google that were expressly built with the user experience (UX) in mind. 

For them, apps, tools, and platforms live and die by navigability, accessibility, consistency in design principles, and relevance to their needs. Unfortunately for payer organizations, many internal applications—like those vital to claims processing, rule configuration, billing eligibility, etc.—are outdated, difficult to use, and even harder to look at.  

Luckily, payers don’t have to re-write entire applications to create more seamless, efficient, and optimized UX. But they do have to redesign and optimize them—which means understanding existing pain points, identifying user personas and use cases, and continually collecting feedback throughout the redesign process. 

Think of it as rehabilitation rather than rebuilding. With the right partner to help figure all this out, payers can leverage tools and tactics like customer journey mapping, focus groups, and A/B testing. On the strength of these methods, we’ve seen organizations roll out re-designed UIs without interrupting day-to-day operations. 

2. Make it easy for providers 

Virtually all insurers now think of their members as customers, and many are beginning to roll out user-friendly apps and websites to help members better navigate their coverage and more easily make decisions about their healthcare. While these member-as-customer efforts have become table stakes, many insurers still fail to recognize that providers also need their experiences improved. 

Provider offices are asking for the same sort of customer-first experience, with easy engagement as a top priority. For example, if providers are unable to easily verify member eligibility online, they are more likely to become frustrated and dial up your company’s call center—a drain on resources, labor, and operational efficiency, taking time away from patient care or other important tasks while also unnecessarily occupying call center reps who could otherwise be assisting members. 

Payers should modernize their provider portals to make the member search process easier. Doing so will increase the speed with which providers can submit claims, pull reports, and verify patients. 

This can have substantial benefits: For example, improving provider portal self-service and functionality decreased monthly customer service call volume at one payer organization we worked with by 19%—a drop of more than 1,000 calls—a considerable savings of time and resources.   

Note, however, that enhancing digital portals does not—and should not—mean that each organization needs to be creating its own new portal. Payers must be working together to rationalize portal sprawl, reducing the increase of different portals providers might have to interact with—while working to create a one-stop shop for a given provider to access patient benefits. 

Keep the immediate focus on microservices that can streamline and simplify experiences—all while investments are being made in working with other payers and providers to deliver a singular, outstanding experience.  

3. Encourage self-service by building intuitive digital experiences 

The healthcare industry has dragged its heels with providing intuitive member experiences online. Stymied by conflicting priorities (e.g., a focus on internal vs. external audiences) and backend coding barriers, payer portals tend to frustrate members rather than support them. 

Something as simple, for instance, as having your provider search automatically narrowed down by your particular network and auto-populate based on your IP address, can be a real challenge—and can carry tangible consequences. 

Now—amid a post-pandemic, widespread shift to digital health—is the time to invest. Research shows about $8 in avoided costs per call when members leverage digital self-service for basic tasks such as finding a provider, managing enrollment in health programs, and downloading ID cards. 

We’ve seen the results firsthand. In one case, building a new, mobile-friendly online member portal redesigned around the most frequently searched information drew 43% more unique visitors to a payer’s website and spurred a 51% increase in repeat visitors.  

At another organization we worked with, a rebuilt employer-focused website that permitted real-time changes to eligibility garnered impressive results. By consolidating workflows, redesigning navigation, providing simple reports for download, and offering a more intuitive view of groups and subgroups, the payer’s website drew 50,000 unique business users in the first quarter of its launch alone. The organization also observed dramatic changes in user behavior, including a threefold increase in visitor return rate, a bounce rate reduction of over 90%, and a 30% increase in average session length.  

These are the kind of performance metrics we expect to see when digital experiences are prioritized and delivered. Efficiencies and engagement like this are attainable for any organization willing to invest the time and resources. 

4. Create knowledge centers for employee support 

When it comes to onboarding new employees, many payer organizations still rely on bulleted Word documents outlining roles and responsibilities, locally stored standard operating procedures, and inefficient shadowing of supervisors. This lack of sophistication can be particularly burdensome during busy periods of the year—like open enrollment—and can be a detriment to employee retention in a tight labor market.  

One solution is to create a digital knowledge base. By digitizing processes for creating, maintaining, hosting, and sharing system documentation, organizations can drive operational efficiencies in as little as three months.  

For example, one payer’s adoption of ScreenSteps—an award-winning knowledge management application—allowed its product teams to create step-by-step, internal training guides 75% faster and to convert 600 training documents into a new, digestible format. Those developments led to a seamless rollout of documentation that employees could interact with in real-time, via demos, training, and Q&As guided by natural language processing tools. 

5. Automate mundane processes

To reorient employees to focus on high-touch, high-value work, payers should identify low-value tasks in their operations—such as manual data entry, re-keying of group information, and website verification checks—and automate them whenever possible. 

For one payer organization, we were able to deploy three autonomous bots to communicate with users through Outlook, verify provider and office credentials, alert users to exceptions with documentation for audits, and flag potential issues for review. By leveraging Robotic Process Automation (RPA) technology over these processes, the payer was able to save over 3,200 hours of labor in a single year, while reducing the time needed to verify a provider from 15 to just two minutes. 

6. Rethink technology rollout strategies 

In the early days of app development, launching new applications without proper preparation or feedback was more commonplace—but in today’s digital-first landscape, it often creates undue frustration for end users who expect their input to help guide design and training. 

It’s why we help our clients re-think their rollout strategies and understand all dimensions of operational impact with new technologies. Developing a focused operational readiness plan will ensure increased adoption and swift identification of issues—and lead to increased employee satisfaction. Today’s payers can increase adoption by creating a pilot program that gathers feedback before launch, thereby ensuring smoother interactions and higher adoption rates. 

Other highly effective techniques to support the rollout of new technologies and tools we’ve employed with our clients include: 

• the preparation of a digital support catalog that includes how-to guides, FAQs, and other documentation on any new applications before and after launch;  

• tailoring training offerings such as train-the-trainer, webinars, 1:1 support sessions, and office hours—to both their applications and users; 

• building an application “scavenger hunt,” in which a team of four to five employees explore an app in a gamified way to further encourage adoption and showcase key functionalities 

7. Refresh your organization’s digital approach 

In many ways, this seventh step is inclusive of each of the six steps we covered. It gets at not just the operational, technological, and procedural shifts that are essential to being a digital payer organization—it also highlights the need for a different mindset to support, drive, and sustain those actions and tactics. 

A major part of that mindset is understanding that none of this is one-and-done, that “digital” is not some kind of destination an organization reaches—it’s a new way of operating that puts stakeholder experiences first, prioritizes accessibility and integration, and keeps fragmented operations in the past where they belong. To us, that means adopting a new, innovation-first approach.   

Since you can’t innovate without understanding where you are (and where you’ve been), a huge component of this innovation-first digital mindset is establishing key performance indicators, setting up regular reviews, and implementing feedback mechanisms to support continuous improvement. It’s about treating what your organization does, what it provides very deliberately and consciously as discreet commodities—products—that can (and must) be constantly evaluated, refined, and recalibrated. It’s why we say the work is never done—an innovation-first is about developing business processes and a culture that prioritizes, incentivizes, and facilitates ongoing digital improvements in measurable, repeatable ways.  

Then transformation—to any extent or degree—becomes a matter of getting specific wins with dedicated resources especially supported and incented to do so. 

That’s the best way to avoid you and your teams being overwhelmed or buried by unrealistic expectations and cutting corners as you grasp for results. 

Digital payer organizations deliver results faster, smoother, and more efficiently 

The digital revolution is well underway, and many payer organizations are quickly falling behind. The benefits of doing so are clear—but not only in terms of increased efficiency and reduced costs. As payers go digital, they’ll also find they’re able to invest in and integrate programs that have a direct impact on their members’ health.