According to recent Cognizant-sponsored research, to boost digital usage and member loyalty, healthcare payers need to prioritize investments in analytics, awareness, strategy and design, say Bill Shea and Jagan Ramachandran, leaders in Cognizant’s Healthcare practice.

高知特（Cognizant, 一家信息技术专业服务公司）医疗保健业务负责人比尔·谢（Bill Shea）和贾根·拉马钱德兰（Jagan Ramachandran）说道，根据最近由高知特赞助的研究，为了提高数字化利用率和会员忠诚度，医疗保健付款人需要优先考虑分析，宣传，战略和设计方面的投资。


We built it, but they didn’t come. Such is the lament of many healthcare payers that have invested heavily in digital tools and capabilities for their health plan members. Based on our 2021 Voice of the Member national survey, conducted in partnership with HFS Research, plan members are still slow to embrace the digital tools provided on payers’ apps and websites.

我们构建了它，但是他们没有来——这是许多医疗保健付款人的哀叹，他们为保健计划成员在数字化工具和功能上投入了大量资金。根据我们与HFS Research（一家全球分析机构）共同开展的2021会员之声全国性调查，保健计划会员对医疗保健付款人的应用和网站提供的数字化工具的接受依然进展缓慢。



From our perspective, these lagging adoption rates are a result of payers underinvesting in awareness campaigns, analytics, strategy and design. Here are the steps payers can take to address these critical components of successful digital adoption.

从我们的角度来说，这些滞后的利用率是由于付款人在宣传活动，分析，战略和设计方面的投资不足。投资者们可以采用以下步骤，来解决这些成功采用数字技术的关键要素。

1. Aggressively promote awareness of digital capabilities.
Our research over the last six years has shown increasing enthusiasm among members for conducting health plan transactions digitally. Yet even when health plans build desired digital features, members don’t use them. Our current survey shows that in 2020, when telehealth use was growing by 24%, 39% of plan members used telehealth capabilities — but from third-party service providers, not their health plans. At least one reason why is that 40% of members said they didn’t know their plans offered a telehealth option.

积极提升数字化功能的宣传
我们过去六年的研究显示，会员们对以数字化方式进行保健计划业务的热情越来越高涨。然而，即使保健计划构建了会员们所期望的数字化功能，他们也不会使用这些计划。我们最近的研究表明，在2020年，远程医疗的使用增长了24%，39%的计划会员使用远程医疗功能——但是是来自第三方服务供应商，而不是他们的保健计划。造成这样的原因中，至少一个是40%的会员表示并不知道他们的计划中提供了远程医疗服务。

Payers must close these awareness gaps. Many do a poor job of promoting the tools they have and/or bury them several layers deep on their websites and don’t push them out to members when/where they need them most.

付款人必须消除宣传方面的差距。许多人在推广他们所拥有的工具时做得很差，或者这些工具在他们的网站上埋得很深，（打开）好几层（菜单才能找到），并且没有在会员最需要的时候或者在他们最需要的地方将其推出。

While payers often tell us, members don’t interact with them frequently enough to learn about their digital capabilities, the experience in the property and casualty insurance industry negates that excuse. The average consumer has far fewer property and auto claims in a year than they do healthcare claims. Yet P&C insurers enjoy much higher digital adoption rates than healthcare payers do, according to our research.

虽然付款人经常告诉我们，会员与他们的互动不够频繁，无法了解他们的数字化能力，但财产和意外伤害保险行业的经验否定了这个理由。普通消费者一年的财产和汽车理赔要比医疗理赔少得多。然而，根据我们的研究，财产和意外险（Property & Casualty，简称P&C）公司的数字采用率比医疗保健付款人高得多。

Why? P&C companies continually promote their apps and digital capabilities in their advertisements, websites, social feeds, etc. While they may use the apps infrequently, P&C customers do download them. Health insurers should similarly tout their digital capabilities in their marketing campaigns.

为什么？ P&C保险公司不断地在他们的广告，网站和社交媒体等推广他们的应用程序和数字化功能。虽然P&C保险客户并不经常使用这些应用，但确实会下载这些应用。类似地，医疗保险公司应该在他们的营销活动中去推销他们的数字化功能。

2. Make foundational investments in analytics.
Payers won’t get the value they expect from digital initiatives without strong analytics. Analytics and intelligence are prerequisites to anticipating member needs and prompting them to use a digital feature or other next best action in an app or on a website.

在分析方面进行基础性投资。
在没有强有力的分析时，付款人无法从数字化方案中获得预期价值。分析和智能是预测会员需求以及促使他们在应用程序或网站中使用数字功能或其他次优操作的先决条件。

Analytics are also invaluable for learning about member needs. For example, most payers view call center deflection as a win. Analytics can help achieve that goal by learning from data about why and when members call for help so that payers can anticipate and proactively address those issues. If the data shows nine out of10 members contacting the call center for upxed deductible data after an emergency department visit, that function can be built into an app or website and advertised.

为了了解会员需求，分析是无价的。例如，大多数付款人将呼叫中心转移视为一种胜利。通过从数据中了解成员寻求帮助的原因和时间，分析（能够）帮助实现这个目标，以便付款人能够预测并主动解决这些事情。如果数据显示，10名会员中有9人在急诊科就诊后联系呼叫中心获取最新的免赔额数据，则该功能可以内置到应用程序或网站中，并进行广告宣传。

3. Adopt business-led strategy and design for each digital initiative.
Consumers today expect great digital experiences that payer tools don’t seem to deliver. However, health plan members reported unsatisfying experiences with payer tools, even when these tools offer self-service and other functions, they want most, such as provider search and cost estimation (see chart).

3.为每项数字化计划采用业务主导的战略和计划
消费者如今希望卓越的数字化体验，但是付款人工具似乎无法兑现。然而，保健计划会员报告说他们对付款人工具的体验并不满意，即便这些工具提供了自助服务和他们最想要的其他功能，比如提供程序搜索和成本预估（见图表）


To avoid delivering disappointing member experiences, payers need to ensure the business, not IT, is leading these initiatives. In turn, the business must lead with in-depth strategy and design activities to ensure the digital capability meets actual member needs while creating business value.

为了避免发布令人失望的会员体验，付款人需要确保业务而非IT主导方案。相反的，业务必须以深入的战略和设计活动为先导，确保数字化能力满足实际会员需求，同时创造业务价值。
原创翻译：龙腾网 http://www.ltaaa.cn 转载请注明出处


Whereas business-led digital development follows a rigorous methodology that includes creating personas and journey maps and using outside-in analysis for examples of how other industries deliver similar solutions, IT-led development often starts with technology sextion, and then fits processes to the technology’s capabilities. The business-led approach fully scopes out member needs first. These needs then drive the technology architecture design and technology sextions so that the technology serves the business vision vs. defining it.

业务先导的数字开发遵循严格的方法论，包括创建人物角色以及行程地图，利用对其他行业提出的类似的解决方法的例子的由外而内的分析，而IT主导的开发经常从技术选型开始，然后根据技术能力调整流程。

A large health plan we worked with took this approach to create new experiences for how brokers interact with members. We developed and designed personas, user journeys and eight future-state business processes before developing technology requirements.

一个我们合作的采取这个方法的大型保健计划创造了为经纪人如何与会员互动新的经验。在发展技术需求之前，我们开发并设计了人物角色，用户旅程和８种未来状态业务流程。
原创翻译：龙腾网 http://www.ltaaa.cn 转载请注明出处


4. Change funding mechanisms.
It’s accepted practice today to spend heavily on implementation while strategy and design efforts receive limited funds despite being prerequisites to successful outcomes. One organization we worked with was trying to build an industry-leading artificial intelligence model but lacked adequate budget to estimate ROI. Organizations must reallocate more budget to strategy and design efforts.

４.改变筹资机制
如今，一个公认的事实是尽管战略和设计是取得成功的先决条件，但是在实施上耗费大量资金，获得的收益却有限。我们合作的一个组织曾经尝试构建工业主导的人工智能模型，但是缺乏充足的预算来估计投资回报率（Return On Investment，简称ROI）。组织必须重新分配更多的预算用于战略和设计工作。

Advances in platform solutions that minimize customization needs support this funding shift. Organizations also must redefine how they identify OpEx and CapEx spend because many strategy and design efforts (e.g., journey maps, process models, business architecture, etc.) are critical to building required future capabilities and may be capitalized.

将定制需求降至最低的平台解决方案的发展支持了这一资金转移。组织还必须重新定义他们如何确定运营支出（Operating Expense，OpEx）和资本支出（Capital Expenditure，CapEx），因为许多战略和设计工作（如行程图、流程模型、业务架构等）对于构建未来所需要的功能至关重要，并且可能被资本化。

Our study revealed a number of immediate investment priorities for payers, including tools for estimating procedure costs, looking up benefits, searching for providers, finding plan options, reviews and features, checking on claims status, and calculating out-of-pocket expenses. But to realize high adoption and commensurate returns, payers must build these capabilities on a foundation of analytics and business-led strategy and design, followed by strong awareness campaigns.

我们的研究为付款人揭示了许多当前的投资重点，包括估算程序成本、查找收益、搜索提供者、查找计划选项、审查和功能、检查索赔状态以及计算实付费用的工具。但是为了实现（数字功能的）高使用率和相称的回报，付款人必须基于分析和业务主导的策略和设计构建这些功能，其次是强有力的宣传活动。

By taking this approach, payers will set the stage for future member interactions that are more relational vs. transactional, such as health coaching, which will build loyalty and market share.

通过采用这些方法，付款人将为未来的会员互动创造条件，这种互动关系比交易关系更密切，例如保健指导，这将建立会员忠诚度和市场份额。