Digital Transformation for Healthcare Payers

>>>Digital Transformation for Healthcare Payers

Our last blog on Digital Transformation introduced the concept of digital maturity. We described the two dimensions of digital maturity – digital intensity and transformation management intensity. In the post, we also described the quadrants of digital maturity for organizations and industries.

We will now look at how Healthcare Payers can benefit from Digital Transformation.

The vast majority of Healthcare Payers find themselves constrained by aging IT systems hampering their ability to innovate, respond to customers, and improve operational efficiency.  To thrive in today’s dynamic environment, Healthcare Payers must recognize and embrace the following essentials that generate the most transformational impact:

Customer experience: Customer expectations in health care are similar to those in other industries; however, Healthcare Payers are significantly behind other industries, such as retail, in responding to their customers. According to the Health Research Institute (HRI), consumer perceptions are built increasingly through non-traditional modes such as mobile devices. One third of consumers said they would be willing to switch insurance if another company offered a better experience. Health insurance has typically been focused on plans and subscribers, but it must now see the need to be customer-centric and engage its customers in a holistic way.

Mobile engagement: In a recent survey, 78% of respondents stated that the health care/life sciences sector held the greatest potential for mobile business innovation. Mobile technologies have become ubiquitous among health care consumers and professionals. The healthcare industry is simultaneously moving towards a delivery model that is patient-centered and value-based. By empowering patients through mobile apps, Healthcare Payers will reduce cost that they can invest into their core business activities. Enterprise mobile solutions have the potential to create operational efficiencies with Payer organizations, improve customer satisfaction, reduce cost, and support innovative sales and marketing approaches.

Analytics: Healthcare Payers are facing a seismic change in their business models, and with all large scale transformations there are opportunities. Realizing these opportunities depends on an organization’s capability to gain intelligence from information. Big Data solutions allow Payers to integrate high volumes of high velocity data of different varieties to enable diverse initiatives. The ability to capture, integrate, and gather intelligence from large data sets will be vital in realizing objectives such as:

  • Improving outcomes through mobile initiatives
  • Detecting and minimizing fraud and checking accuracy and consistency of claims
  • Improving quality of service and outcomes by using predictive analytics to proactively identify individuals who could benefit from preventive care and support prevention initiatives

Digital processes: While the natural tendency is to view digitization from an IT perspective, transformation in B2B processes can substantially improve operational efficiency. Digitizing business processes will allow Healthcare Payers to visualize and measure the work that is performed in real time. Digital processes and analytics provide payers with insight into the efficiency of their business. Leveraging this information allows Payers to maximize productivity, profitability, and quality.

Healthcare Payers today are facing more challenges than ever before. To flourish in this changing environment, Healthcare Payers must redefine themselves to become more flexible, nimble, and responsive.

Digital Transformation presents opportunities and gains for Healthcare Payers. Leveraging the right digital opportunities for strategic growth is instrumental in reaping significant rewards.

Hitesh Nangrani is a Consultant II at SDLC Partners, a leading provider of business and technology solutions. Please feel free to contact Hitesh at with any questions on this blog post or to further discuss digital transformation.