A Digital Roadmap for Healthcare Payers

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Wise selection of technology, confident adoption of transformation, along with people and cultural change are key for successful digital transformation in the healthcare insurance industry.

In a previous post, we examined the progress of the healthcare insurance industry’s quest for digital transformation. Payers, in general, appear to lag behind other businesses and are wrestling with strategic questions as they lay the groundwork for a complete technology conversion. While many firms have a sound foundation for digital, they are cautious and somewhat conservative when it comes to implementing their plans.

The thought-provoking book Leading Digital[1] encourages firms to become masters of digitization rather than victims by becoming proficient in:

  • Digital capabilities—the ability to define the value of technology and then leverage it to make productivity-enhancing operational changes
  • Leadership capabilities—willingness to create and nurture a digital culture and agile processes that enable transformation.

A Digital Master’s Path Forward

But where to start? First, insurers must lead through wise selection of technology and confident adoption of transformation versus assuming the traditional wait-and-watch approach. For instance, when compared with newly-collaborative banks, many payers are tapping their brakes when it comes to innovative technologies such as Application Programming Interfaces (APIs) and blockchain. Although broad commercial adoption of blockchain has yet to take hold, many banks are testing use cases, such as those for cross-border payments and digital currencies.

After setting clear and ambitious digital transformation targets, payers must also keep in mind that piecemeal acceleration built on siloed initiatives often fails to achieve enterprise-wide results—and thwarts the realization of full benefits.

Digital transformation in healthcare must purposefully move beyond member portals and ad-hoc analytics initiatives and instead filter throughout the organization as an integrated digital strategy. For instance, a fundamental and enterprise-wide goal might include reducing the firm’s total number of required financial transactions, which would streamline system complexity and improve overall efficiency.

From a customer-experience perspective, digitization is a boon. Consider a patient who visits three medical specialists, is prescribed tests at four different labs, and finally visits three different pharmacies to pick up medication. The patient must then visit the payer portal 10 times to track disbursements to 10 different providers.

However, insurers that leverage technologies such as API and blockchain take advantage of seamless data access and exchange and can offer the patient a single snapshot of all their transactions. The result? A simpler, more efficient payments’ experience for the member and all stakeholders involved.

Digital capabilities built through new, useful technologies will streamline the healthcare experience while also reducing administrative costs and overhead by integrating diverse systems and automating data exchange and processes.

People and Culture Change is Key

Complete, enterprise-wide digital acceptance and advancement are contingent upon a consistent and nurturing transformational environment and organizational culture.

Senior management commitment, as well as the alignment of business and IT goals, are vital to ensuring that digital change supports the organization’s strategic vision. Alignment helps payers to make the right technology investments and design an ROI-based plan. Another critical behavior is workforce enablement that gives employees mobility and flexibility through advanced digital tools and a BYOD set-up. Innovative devices help agents take services directly to customers while empowered with in-depth analytics insights, which, in turn, drive more personalized customer experience.

Finally, efficient digital transformation requires a significant organizational realignment to ensure change at both the culture and process levels. Leading payers are now investing in digital innovation offices and specialist positions for areas such as user experience, IT, and process transformation to help chart the organization’s course on the digital advancement roadmap.

Why, even the digital capabilities scale-up process is going digital to help take the time and guesswork out of transformation. Platforms such as Capgemini’s Accelerated Solutions Environment (ASE) and Smart QA Testing platform provide an agile environment for firms to rapidly develop and deploy digital initiatives.

In today’s competitive market, first-mover advantage is more important than ever. Next up, we will look at how payers can leverage digital transformation to become market leaders.

[1] Leading Digital: Turning Technology into Business Transformation, George Westerman, Didier Bonnet and Andrew McAfee; Harvard Business Review Press, 2014

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