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Deepen health plan member connections by delivering personalized experiences

Jitesh Rohatgi,
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In the U.S., open enrollment for 2020 marketplace coverage begins November 1st. By this time, healthcare payers should have been actively educating consumers on their plan’s coverage and benefits, so consumers have the information they need to choose the options and coverage that best fit their personal needs – and payers can guide members to the coverage that helps add value.

However, healthcare payers are having trouble connecting with existing members. In healthcare, and across all industries, the response rate for marketing and outreach campaigns is just 1%. That means 99% of members consider your messaging irrelevant.

The problem is traditional member engagement programs do no more than push information with outreach campaigns in large batches to different groups on different channels – and often members are bombarded with multiple disconnected campaigns from very different groups within the same payer organization. This one-way style of engagement focuses only on what the healthcare payer wants, not on what the member or consumer really needs – and is reflected in low campaign response rates.

To drive deeper, more valuable member connections that are relevant and create opportunities to influence health outcomes, healthcare payers need to personalize the messaging in every interaction.

Nothing is more personal than health

In a massively connected world powered by data, health plan members expect you to really know them. But with so many different groups, channels, programs, and data to manage, healthcare payers struggle to know each member on an individual level. Yet, to influence member outcomes, you need to be able to empathize with each individual and proactively adapt to their specific needs.

For example, think about even the most basic member needs, such as the process involved in picking a Primary Care Physician. For someone enrolled in a Medicare Advantage plan, it’s not uncommon to have a PCP randomly assigned at enrollment. Imagine, instead, if you could use artificial intelligence to analyze that member’s data for criteria like language, location, and hospital preference – plus, physician criteria, such as hospital affiliation and if they are accepting new patients – then apply decisioning to suggest the best PCP to fit that member’s unique needs.

The ability to personalize even more complex needs has even greater potential to provide value to both the member and payer. For example, in the case of a member being treated for a serious illness, the most relevant messaging might focus on disease management instead of selling unrelated programs or services. The ability for payers to demonstrate an understanding of the individual goes a long way in establishing trust and deepening relationships.

Use AI and decisioning to guide personalized experiences

Health organizations collect plenty of data, and some payer organizations are already applying analytics to that data to help design outreach campaigns. But to create personalized conversations and experiences, you need to apply real-time decisioning to that data. You need to analyze each interaction as it’s taking place to understand exactly what that member’s situation is, and then make decisions about what is the best message or action for that member in that moment.

True personalization is not just about making wellness, marketing, or sales offers. Instead, true personalization happens when payers consider the current context of a member engagement, plus all the retention, service, claims, wellness, or risk options that are available. Every option is modeled and examined in real time to generate a recommendation for the next best action that best balances member relevance with business value. AI, analytics, and decisioning help you calculate the right approach for a specific person and situation based on their needs and your organization’s goals.

Organizations are finding real value in personalization

Even large, established healthcare organizations recognize that consumer experience is important, and are taking steps to move to a more personalized, member-centric engagement approach. For example, at PegaWorld 2018, Blue Cross Blue Shield of Arizona described how it used Pega Marketing to realize its vision of personalized, omni-channel, customer journeys.

By understanding the context of each member interaction, as well as each member’s unique needs, payers can generate personalized experiences that will have the greatest impact on your organization.

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Assunto: Experiências de cliente personalizadas Industry: Saúde Área do produto: Atendimento ao cliente

Sobre a autora

Jitesh Rohatgi, Pega’s global director and healthcare/life sciences principal, has over 15 years of experience advising life sciences and healthcare organizations on the most effective use of CRM, MDM, and AI technologies to improve clinical safety and patient care.

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