Patient or Member? How About Calling Them Customers?

What are individuals called in a health plan? Members. What are people called when they meet with a provider? Patients. What is an individual person referred to in any other industry that uses end-to-end solutions? Customers.

The “unique” needs of a member vs. a patient in the healthcare or health insurance setting aren’t really unique at all. At the end of the day, these needs are customer needs.

Not surprisingly, with the growth of government-based healthcare programs like Medicare, Medicaid, and Individual/Exchange lines of business, the migration from a dominant employer-based “customer” Business-to-Business (B2B) relationship has transformed and become more of a consumer-driven Business-to-Consumer (B2C) environment.  Health plans must find ways to treat members as customers and look at how to provide an end-to-end solution that best serves their needs.

How can different types of health plans cope with the consumer-driven B2C growth?

There are different paths to get there as plans can use their inherent strengths to meet this changing demand.

For larger plans, their respective budget capacity (and subsequent ability to invest in scalable solutions) have enabled them to heavily invest in front-end “consumer-experience” technology. While mid-sized (generally regional) type plans, the closer relationships between payer and provider and the willingness or, in some cases, equity structure (health plans that are owned or closely affiliated) provide a mechanism to more readily share data and collaborate on end-to-end processes, allowing members to enjoy a combined experience from a single entity.

Regardless of the means to “get more consumer-driven,” the common foundational technical requirement investment are back-office applications that are interoperable, data-integrity true, and secure. To move to the next generation of where healthcare is going, health plans must modernize their core system.

About the Author

Mike Comick

Mike Comick
VP, Strategic Partnerships 

Mike Comick is a HealthEdge Vice-President, leading the company’s Strategic Partnership program.  Mike has over 35 years-experience in health insurance core systems and associated business transformation.  Prior to joining HealthEdge, Mike was co-founder of Healthcare Technology Management Services (which was later acquired by Emdeon), a partner with First Consulting Group, and Vice-President of the Core Claims/Administration practice at CJ Singer / Gartner Group.  Mike has published company profiles, market win/loss reports and health plan IT aggregate budget analysis.

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