Recognizing the need to improve capabilities and update legacy systems, more and more payers are moving to upgrade their technology. But before embarking on ambitious, expensive IT initiatives, payers need to acknowledge some of the realities of the health insurance industry – mainly, that systems are historically fragmented, built to suit the needs of individual business units. To pivot toward strategic, enterprise-wide solutions, payers should focus on building customer engagement hubs that achieve two goals: putting their customers’ needs first and providing holistic views into every aspect of their businesses.


Why a consumer-first strategy?

In this story, “To survive in the digital health era, payers must put the consumer first,” author Heather Mack writes, paraphrasing Basil Kayyali, senior partner at management-consulting firm McKinsey & Company, that health insurers “are not set up to work in a digital way – they have spent the past 20 or 30 years focusing on driving efficiency and getting silos of functionality, while the true innovation comes from transforming the consumer experience.” The truth is, most consumers view health insurance as a commodity and base their purchasing on price. Health insurers need to alter this perception by moving past their traditional business models and creating customer experiences that are positive, proactive and educational.

Moving towards a customer engagement hub

Fragmentation among payers’ technology and business processes leads many IT executives to apply Band-Aids to their tech problems. These solutions tend to have limited functionality, require extensive customization or lack the built-in industry workflows to address the fundamental need to capture 360-degree views of their customers. Gartner estimates that “by 2018, 60% of large organizations will design a customer engagement hub (CEH), yet only 20% will select the correct technologies to make it work.” A customer engagement hub that is centralized around a business-initiated CRM strategy would empower healthcare payers to:

  • Ensure that processes are aligned to the needs of customers
  • Provide a coordinated effort built around the customer experience
  • Create the necessary tech infrastructure to quickly scale and adapt in real-time
  • Focus on a holistic strategy vs. solving problems based on urgency
  • Encourage innovation across enterprise ecosystems

What goes into a consumer experience hub?

In order for any enterprise solution to enable a cross-departmental transformation, business boundaries will need to be removed for tighter collaboration. Doing so should allow the organization to speak in a consistent voice across all brand- and consumer-facing interactions and channels. That’s one of the key values described in this Gartner white paper,Ten Steps for Planning Your Customer Engagement Hub” A CEH, according to Gartner:

  • Is a “system of systems.”
  • Places greater emphasis on the explicit two-way value exchange between the customer and the enterprise.
  • Has built-in internal collaboration and channel-routing tools to connect employees across departments, employees with customers, and customers with their peers.
  • Provides several layers of analytics to manage optimized and personalized customer interactions.

A well-built CEH ensures that there is always two-way dialogue with customers or prospects, and enables tighter communication in cross channel, cross-departmental interactions. Meaning real-time collaboration and dialogue would happen automatically between marketing, sales, digital commerce, customer service and operations.

Why a CRM is a core component

Plagued with organizational barriers and struggles to implement a consumer-driven business model, the health insurance industry will require a solution that is transformational to customer experience and innovative across the enterprise. By moving towards industry-specific CRM technologies, payers can accelerate the transition towards a customer-centric model.

While there is a great desire to wait for as long as possible before replacing, or in some cases enhancing, legacy CRM technologies, there is value in making the move sooner rather than later.

This is especially true where various lines of business and customer data or segmentation overlap, and where it’s imperative for the organization to react in real-time to managing risk, increasing renewals, streamlining operations or reducing wait times on service center requests. As this Gartner study says:

“The changing and expanding nature of the CEH will require flexibility to incorporate both upstream and downstream CRM systems that are introduced to enhance the customer journey with the brand. In the former, that might mean adding field service data over time. In the latter, it might be adding digital marketing and loyalty marketing applications and data over time”

Those payers who elect to implement a consumer-experience hub with an industry specific CRM will immediately synchronize all lines of business with a coordinated view into all customer data. That will ensure greater enterprise consistency, improved delivery and processes that will increase member lifetime value through greater customer experience.

Additional Sources: (Gartner subscription required)

ID: G00290990 Gartner: Ten Steps for Planning Your Customer Engagement Hub

ID: G00308750 Gartner: Develop a Strategic Plan to Integrate Your Customer Engagement Hub