STRATEGIC GUIDANCE & EXECUTION IMPROVES MEMBER EXPERIENCE FOR HEALTHCARE PAYER
Focused investment on member experience reaps rewards
SITUATION
A large payer engaged Capto to develop a member experience roadmap for strategic technology investments. The payer was consolidating recent acquisitions and had not yet decided if or how to consolidate multiple contact centers and their underlying technology. Additionally, they had not determined which markets should drive these consolidations – commercial, government or individual.
Furthermore, as a result of the acquisitions – and their lack of a clear provider lifecycle management platform – the payer acknowledged it did not have a good understanding of the data sources necessary to fully complete Capto’s scoring methodology across the entire enterprise value process model.
THE SYNAPTIC SHIFT
Many payers continue investing in contact centers and omnichannel “digital front door” projects to improve member service with limited measurable improvement in member experience over the past 5+ years. Capto helps focus those member service investments while shifting spending to programs that more effectively improve the overall member experience. Savvy payers will quickly course-correct to outperform the competition.
The best way forward often involves prioritizing one core member experience at a time. For this client, Capto helped drive a data-enabled decision to start with the Access to Care experience. This area was chosen for its high correlation to NPS improvement and its alignment with the payer’s competitively disadvantaged provider management capabilities in some markets. None of the payer’s acquired or legacy capabilities presented a solid foundation moving forward.
At the outset of the engagement, Capto worked with the payer’s team and used the APQC Process Classification Framework (PCF) for Health Insurance to document the processes, activities and tasks associated with Access to Care. Once 80% complete, the team proceeded with scoring the remainder of the PCF that impacted Access to Care for government markets.
The resulting analysis produced a prioritized set of technology, process and workforce initiatives that were then injected into the annual planning cycle.
RESULTS
The first-year Member Experience roadmap and its focus on Access to Care set up Understanding Benefits and Costs as the next core member experience to address, driving priorities for technology, process and workforce integrated into the annual planning cycle as shown below:
Quarters 1-4: Consolidation of provider management operations
Quarters 1-8: Project to develop a new provider lifecycle management platform that would be the basis for consolidated operations
Quarters 2-5: Project to modernize provider contact center technology
Quarters 3-8: Project to drive total knee candidates to $0 Deductible Providers
Quarters 4-8: Project to drive total hip candidates to $0 Deductible Providers
Delivering an end-to-end solution from strategy through execution, Capto ensured operational imperatives and financial outcomes were met. Members noticed a much-improved experience, leading to reduced churn and higher revenue growth.
