"Healthcare consumerism" is a phrase that has been bandied about for years by health insurance plans, but in practice it has often meant pushing more financial responsibility onto the patient, rather than reconstructing healthcare with the consumer's real interests at heart.
Things may be changing, however, as suggested by a panel discussion at the 2013 AHIP Institute on Thursday. Tom Paul, chief consumer officer at UnitedHealthcare, and Tim Johns, senior vice president and chief consumer officer at the Hawaii Medical Service Association (HMSA), agreed on the importance of redesigning health plans around the consumer's vision of value.
Both executives said health insurance plans must move from a more traditional view of the healthcare system to a focus on the individual within that system.
"A consumer focus is about an organizational emphasis on the individual consumer," Paul said. "You need to marry a strong definition of the consumer with a clear passion toward serving that consumer throughout your organization."
Paul said that a consumerist focus required a culture change at health plans.
"UnitedHealthcare is a very metrics-driven organization, and the consumer is often viewed as the 'soft' part of the business," he said. "But we decided to make it a metrics-driven part of the organization" to encourage the same focus on driving value for the consumer, he said.
Johns said the strategic planning process was central in shifting a health plan's culture toward a consumer focus.
"A unified mission goes a long way toward getting folks on board (with the consumerist focus)," he said. He said senior leadership at health plans should use the "power of imagery" to help shift staff attitudes. Paul concurred, revealing that senior executives at UnitedHealthcare are encouraged to begin meetings with stories about the customer experience, both good and bad, to help illustrate how the health plan impacts the lives of the real people whom they serve.
Both UnitedHealthcare and HMSA used journey-mapping techniques to display for staff the experience of the consumer in accessing care and then moving through the post-care insurance process. Paul said journey maps provide an end-to-end consumer-level view of the financial and administrative process following the care interaction.
When staff recognize the 'journey' that the customer goes through after care, they begin to empathize with his or her experience. This abets the shift toward a consumer-centric restructuring of healthcare.
"If you're going to be on top of your consumer's needs, you have to be in touch constantly," Johns said. "We can't rely on our intuitions anymore (to adequately understand the consumer). We use data to understand the consumer experience."
Johns and Paul agreed that an increased focus on making the health insurance experience consumer-friendly would inevitably yield growth opportunities for health plans.
"You'll see greater retention and you eliminate the inefficient spend," Paul said. "These benefits derive from growing much more sophisticated about engaging with and understanding the consumer."