Health plans are increasingly deploying a single, digital front door to improve member experience, satisfaction, outcomes and costs.
Health Plans

Personalized care engages patients and improves quality

October 17, 2019
Health plans are increasingly deploying a single, digital front door to improve member experience, satisfaction, outcomes and costs.
President and CEO

Let’s face it. Patients increasingly expect healthcare organizations to know them and proactively engage with them just as banks and online retailers do. 

That’s why, increasingly, healthcare organizations are deploying a digital front door strategy – with a patient relationship management platform as the foundation – to engage members at every touchpoint along the patient journey. Health plans and provider organizations are using this strategy to personalize patient care and improve patient satisfaction, quality and productivity.

Health Plan Customer Experience

As someone who has worked in and around health plans for most of my career, I know better than most that it’s a rare day when one hears a compliment about a payer. Forrester Research’s Customer Experience Index, which “measures how successfully a company delivers customer experiences that create and sustain loyalty,” validates my experience. 

In 2016, health plans ranked in the bottom five of all industries, just above the airlines.

Distribution of Industry Scores in Forrester's CX Index, 2016

While the health insurance industry had one of the biggest improvements in Customer Experience Index from 2018 to 2019, significant challenges persist.


Source: Forrester Research, Light on the Horizon, 2019


For starters, the best health plan performers scored in the mid to low end of the ok category (65-74 out of 100), and the rest fell into the poor category (55-64). Even more tellingly, “Only 56% of customers feel they can get the help when they need it and that employees know how to solve their issues quickly.”

Interestingly, Kaiser Permanente has scored number one among health plans for many years. Of all the health insurers measured, “It had the highest percentage of customers having effective and emotionally positive experiences and tied for easiest experience with number two Humana.” Forrester posits, and I agree that, 

Kaiser Permanente is an integrated delivery network (IDN) that provides both healthcare services and a health insurance plan. This gives it an advantage over most of its competitors – allowing for more control throughout the entire customer life cycle and for increased transparency with customers and employees.

In other words, Kaiser is poised to have effective and holistic data integration that enables everyone in the organization to know the member and be able to easily access their healthcare opportunities and needs as well as their preferred method of communication. Until now, health plans like Kaiser have had a distinct advantage – the single or digital front door. 

The Digital Front Door

The evolution of data integration capabilities and analytics now allows all health plans to create a digital front door, enabling them to improve member satisfaction, quality outcomes and ultimately costs.

Here’s a look at how the digital front door improves the experience and care of health plan members:

  • Member Journey One: Sarah is a young, expectant mother. Sarah emails her health plan to find out if a breast pump is a covered benefit. Her email comes into customer service. The system identifies Sarah and displays her plan and member information. The member service representative (MSR) determines the breast pump is covered under Sarah’s plan. She replies to Sarah’s email with instructions on how to get one, along with a list of suppliers. 

    The system cues the MSR about the Next Best Action, which is to refer Sarah to a care manager who can support her throughout her pregnancy and delivery. The MSR submits Sara’s information to care management. The referral coordinator reviews Sarah’s case and assigns a care manager, who outreaches to Sarah via email since that’s her preferred method of communication.

  • Member Journey Two: Arlene is a tech-savvy, 40-something member who prefers to access information via the website and member portal. She logs into her secure member account and goes to the benefits tab. She types in mammogram, and based on her plan details, the system tells her that it is a preventive visit with no cost to her. The system then informs Arlene about the providers and facilities she can go to for this service, along with options based on her preferred location near her office. Next to the provider list there is an option for Arlene to have the listed texted to her. Texting is her preferred method of communication so she happily clicks to button. 

    As Arlene is reviewing the provider list, a small screen pops up at the bottom of the website. It is flu season and there are no claims on file to indicate she’s had a flu shot. The screen reminds Arlene of the availability of flu shots, and that the health plan will be onsite at her employer next week to give flu shots. She’s given the option to ‘click here’ to schedule an appointment. She does, and receives a text confirming the appointment. 

There are countless examples of how a digital front door enables a health plan to engage members when they already are seeking information or help from the plan, and to do so quickly and seamlessly using the member’s preferred communication channel. As Forrester noted, 

Customers expect the same high level of service no matter how they choose to interact with your brand at a given moment. Smart organizations are investing in better data management capabilities so that a customer’s data profile (and therefore, their personalization and preferences) flows smoothly and instantaneously between offline and online channels.

Increasingly, health plans and healthcare organizations are following the lead of the banking and airline industries and investing in the technology, analytics and integration needed to elevate their member experience to a member-first approach. Undoubtedly, members will benefit. Health plans will too in the form of higher member satisfaction, improved customer stickiness and retention, more efficient use of resources, and ultimately better health outcomes and cost.