Driving Healthcare Value Through Consumer Engagement Analytics

Whether you are a marketing executive at a large national PBM, a product development executive at a leading health insurance company, or state public health official, in the new world of healthcare, you must be able to answer critical questions about your member population unlike ever before. 

The rapidly changing healthcare marketplace creates unique opportunities for healthcare organizations to transform their existing business models to consumer-focused businesses from plan sponsor or employer-based businesses.

Government regulations are accelerating the shift to consumerism through mandates like the Affordable Care Act (i.e., Obamacare), HITECH Act (e.g., EMR and meaningful use) and other state-based legal changes. Additional factors confounding the shift include continued economic pressure, shifting care delivery models to consumer retail clinics and health system integration (e.g., increased payer/provider collaboration, mergers and integration). Consumer demographics are also changing with aging populations and proliferation of chronic diseases due to poor health behaviors. (For example, approximately 40% of all premature deaths in the U.S. are due to behavior-related health choices.) These marketplace dynamics are causing healthcare executives to rethink their approaches to consumer engagement and how they can best leverage existing and new sources of data for strategic change, competitive advantage and improved consumer health behavior.

Whether you are a marketing executive at a large national PBM, a product development executive at a leading health insurance company, or state public health official, in the new world of healthcare, you must be able to answer critical questions about your member population unlike ever before. The answers to these questions allow you to improve targeted interventions, tailor messaging and customize products to effectively manage your business. Consumer engagement analytics can help you in your journey toward healthcare value by helping you create accurate profiles of your member populations, by therapeutic conditions, product, age, cost and other interesting segments or clusters. It can also enable critical business decision-making by enabling predictive power across consumer profiles, segments, or sub-populations based on group, product, therapy or condition. You may be interested in knowing which consumers are likely to adhere to their medications. Or which consumers are your most costly members due to demographic, group, past claim history, pre-existing conditions or other factors. You may want to know why certain individuals or groups develop higher rates of hypertension or diabetes than others. Consumer engagement analytics can help answer these questions and other interesting questions that affect your business.

Based on the answers to these and other consumer engagement analytics questions, healthcare executives will be able to tailor specific healthcare products to individuals and specific segments based on likely behavior. Executives also will be able to design targeted interventions that drive greater revenue and improved health outcomes. They will be able to optimize business performance by better understanding the cost to serve different consumer segments and be able to price products differently. The key questions remain: How do I begin? How do I pull together disparate data sources within and across the enterprise to enable sophisticated analytics?

Contributed by Kevin Henderson.