Austin Ridgeway, director, HGS Healthcare

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There has been a lot of buzz in recent years about what retail can teach healthcare about consumer engagement. Now it’s time to walk the talk, with many watching and learning from disruption, like the up-and-coming Berkshire-Amazon-JP Morgan venture.

Healthcare has undoubtedly made business-to-customer strides toward 24/7 optimized experience—from nurse triage to customer relationship management and analytical population health management data collection. Both payers and providers are more proactively tracking member and patient interactions to build intelligence for future interactions. Today, data collected are building on historical elements to foster a holistic portrait of healthcare consumers, create the foundation for predictive intent and provide a more seamless experience.

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While healthcare is catching up to retail’s proven tactics in digital convenience and personalization, it’s important to remember that the road to engagement is not easy. The “Uberification of healthcare” metaphor notwithstanding, retail-to-healthcare engagement comparison is far from an apples-to-apples scenario. There are key differences between other industries and healthcare organizations, which have to navigate these market complexities.

Healthcare carries a much greater risk and burden than most other industries when it comes to

The cost of compliance has steadily grown over the past few years, rising 43 percent from 2011 to 2017, according to a recent Ponemon report. Notably, the most heavily regulated industries, including healthcare, show a 106 percent increase in compliance costs for that same time period.

At the top of the list for healthcare is the Health Insurance Portability and Accountability Act (HIPAA), which has undergone regulatory changes to accommodate the emergence of telemedicine and wearable devices that store protected health information (PHI). Undeniably, the healthcare compliance list is long and a moving target.

With all of the state- and federally driven mandates, payers and providers know that even the smallest mistake can result in sanctions by the government, resulting in high costs, oversight and extensive auditing. So, while other industries focus on certification and compliance, healthcare has to abide by a broader pool of more stringent regulations.

How business process outsourcing organizations (BPOs) can help: 

As expert problem solvers BPO providers understand the nuances of regulations and how they can affect businesses from an end-to-end perspective. A trusted BPO partner can deliver payers and providers a core service focus to commit the majority of resources to achieving business objectives. And the global reach of these service providers allows for right-shoring models that ensure compliance standards are met while still providing cost and operational optimization, with implementation of new tools such as robotic process automation.

Although the customer might always be right, it’s not always clear who the customer is in healthcare—unlike retail and other industries. Ask any healthcare supplier, and they may question whether they serve physicians, patients, hospitals or insurers.

Healthcare payers and providers have many users and influencers that they have to take into consideration across all operations. Payers aim to engage and satisfy members, providers and other stakeholders, like third-party administrators. Providers answer to patients, payers and other parties who have a stake in their success. These stakeholders are all influencers of market position, image and, ultimately, success. It’s essential to appeal to and appease these critical stakeholders, to close the loop between all parties to maintain this delicate balance.

 BPOs can address these market challenges, as the right partner will have holistic healthcare lifecycle management expertise that builds long-term relationships to engage and offer exceptional service execution to your members, patients, and other relevant stakeholders. These outsourcing partners typically have a capability set that expands across numerous functional areas within payer and provider organizations. BPOs with a consultative approach will provide healthcare organizations the abilities to manage the expectations of all influencers relevant to the business, from voice to back-office operations. This understanding of upstream and downstream impacts will also assist with driving efficiencies and cost-saving opportunities. Ultimately, as a virtual extension of healthcare client operations, these partners will carry the customer-centric solution thinking that has led other

industries to consumer experience success.

Keeping in mind the bureaucratic and complex nature of healthcare processes, there can be organizational siloing that occurs within operational business units. Take, for example, internal decision making for a health plan’s provider engagement, which could roll up to a different leader than the one who owns member engagement. In this classic example, there can be disconnects, causing higher costs and other operational inefficiencies.

Considerable advantage will be found with a BPO partner that has end-to-end understandings and capabilities across the entire healthcare ecosystem. These service providers are experts at centralizing operations to ensure consistency across all operating units and offer exceptional experience and improved outcomes on behalf of their clients.

Ultimately, to navigate these unique challenges and finally deliver the customer experience found in other buying scenarios, healthcare will increasingly look to the essential accelerators. A greater use of data analytics, robotic process automation, artificial intelligence, and machine learning are key enablers to healthcare transformation—from physician learn and practice medicine to how payers support care delivery. With proven success deploying this innovation, along with customer care learnings from more mature industries, BPOs can help healthcare clients to pave the way to truly improved customer, member, and patient experience.

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