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How to develop a truly seamless payer/provider customer experience ecosystem

Customer experience is a strategy that requires a holistic approach. In saying that, I mean that much more needs to be considered when developing a seamless ecosystem.

In this era of the ACA, or Affordable Care Act, and Obamacare, whether you’re a payer or provider, you have to look at the other side to begin to develop your customer experience strategy.

In other words, if you’re a payer, you have to think about the intersection of how your customer is going to react, from you to the provider, and when they come back.

The customer life cycle in healthcare

As a customer comes into the experience of life cycle in healthcare, they go from being called customer prior to purchasing insurance, to member when they’ve purchased health insurance, and finally to patient when they’re using their health insurance and they require medical attention.

To map out the customer journey, you really need to start before the customer actually buys their health insurance and follow that experience all the way through the journey. This journey includes all of the ins and outs of each entity, whether they are payer or provider, all the way through to aftercare.

Steps in the customer journey

If we think about the steps in this, there are a few steps that we should really look at.

The first one is the customer life cycle — the overall life cycle. Now let’s map the overall journey that an individual will take throughout that area.

Next, we need to separate the areas into defined buckets. The first bucket will be pre-insured, prior to purchasing insurance. The second will be insured once they’ve purchased or made a transaction to purchase insurance. The third will be pre-medical, meaning prior to needing medical attention, but insured.

After that will be medical, when they’re insured and they need medical attention, followed by billing. This is when the transaction occurs at the provider. Following that will be the aftercare phase, when their follow-ups are due, when they need to consider certain things about a wound, prescriptions or what have you.

Who, what, when, where and how

Following this, we need to drill down into each of these areas and really look at the who, what, when, where and how. Who’s involved? What’s being done? When does it happen? Where does it happen? How does it happen?

Once you have done this for each of those six areas – pre-insured, insured, pre-medical, medical, billing and aftercare – then we go one layer deeper. Then we add impact. Who is affected during this phase? And then, what is the impact? Can we quantify what the impact will be?

Once we’ve done all of this, we can then overlay any special occurrences that might happen during the course of this cycle. We can also analyze it for various constituencies. We can analyze it for this type of individual versus that type of individual.

Communicating your customer experience ecosystem

Finally, we need to continually communicate this to all of our employees and to all of our levels of management, and most importantly to the actual individuals. This ensures everyone in the ecosystem understands and has their expectations met.

Defining your customer experience ecosystem shouldn’t be a once-off activity. It needs to be constantly refined over time to make it better and ensure that your organization continues to exceed your customers’ expectations.

Stephen Pappas

With more than 20 years experience in enterprise software sales and operations, Stephen Pappas manages all aspects of Panviva’s North American operations. He previously served as a Director of International Sales with Harte-Hanks Trillium Software, where he took their enterprise data management offering to 54 countries. Other roles have included Executive Vice President of a SaaS software start-up and Director of Sales and Business Development at PageFlex.

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