At this week’s Blue Cross Blue Shield National Summit in Orlando, Blue plan executives are discussing the challenges and opportunities they face in an increasingly complex and uncertain environment.
The regulatory environment has been topsy-turvy: The American Health Care Act was out in March, only to be back in. And the path of the legislation in the Senate is uncertain. The intense drive toward a consumer-centric market, with the related need to invest in new capabilities at scale, has some observers questioning if payers will retain their traditional role.
Despite these shifts and uncertainties, there are still constants in the business that Blue plan executives must get right. It may be tempting to veer away from core principles, but now more than ever, it’s vital to maintain a focus on operational performance, while driving new innovations to grow and retain membership and ensure that we have the capital to evolve, grow, and serve new generations of customers.
What will that entail? We see three critical priorities:
- Partnering with all stakeholders to sustain and improve markets across all government programs (Medicare, Medicaid, and whatever else comes of ACA and/or AHCA).
- Refining operating models to smartly manage costs, picking spots carefully (owning select areas of strategic control), and forming strategic partnerships in other areas to achieve more efficient and effective structures.
- Reimagining payer-provider relationships to ensure they work to deliver real cost savings and an improved value proposition for the consumer.
The common chassis needed for Blue plans to deliver on all of these priorities is a deep and robust understanding of consumers. That’s because insight into today’s health consumer is the root of true innovation. Consumers’ hassles, frustrations, and unmet needs, especially those that fall outside the offerings of traditional healthcare players, can shed light on what offerings will improve their healthcare and health insurance experiences. (See below chart that shows ‘bundles’ of related consumer hassles that share an underlying root cause.)
We know, from research that we did together, that many individuals struggle to follow their care plans and manage their conditions, with significant impact on outcomes and cost. Our research showed that offering members products and services that address a severe hassle or frustration can create a meaningful, high-value relationship — one that is not built on denying claims.
For example, consumers told us they don’t know what to do after a diagnosis puts them on an unchosen health journey; this hassle has led to patient advocacy and navigation offerings from third-parties who promise solutions. Consumers also said they can’t get to a doctor during the work day; this desire for convenient access has led to the rise of virtual visits, and of telemedicine more broadly.
Another interesting finding from our research is that consumers who feel an emotional connection to their health plan are more likely to adhere to a care plan, and more likely to be satisfied with customer service interactions. So creating compelling experience offerings can drive improved customer satisfaction and retention, and also create a connection to the consumer that is also valuable to the insurer. That connection, in turn, can make the system more efficient: driving down medical costs and administrative costs.
Consumer insights like these can help Blue plans understand which strategic control points matter most. Consumers often can’t articulate the solutions they need, and even if they can, what they envision is usually incremental to today’s solutions, rather than transformational.
If Henry Ford had asked consumers in the early 1900s what they needed, they might have told him they wanted a better buggy whip. Instead, he gave us the automobile. True innovation requires a deep, holistic understanding of consumers’ needs and hassles, going beyond their use of and satisfaction with today’s healthcare products. To gain insight into today’s health consumers, Blue plans can capitalize on their deep community roots to connect with consumers, listen, learn, intuit, and create disruptive solutions and the next generation of the healthcare experience.