CRM for healthcare payers: Expanding to care, health and wellness

By Janice Young, IDC Health Insights,

The harbingers abound: 2011 is a year of health and wellness focus for US health plans. Assuming the selections represented in a recent AHIP solutions smart brief are some indication of industry trends and priorities, health and wellness is one of the most frequently reported topics in January. An active topic all month, these items represented over 80% of the daily announcements in the past two days. As the market embraces and invests more into health and wellness strategies, IDC Health Insights research finds a couple key technology disconnects:

• One of the keys to effectively managing wellness and healthy lifestyle programs is data on what works: what programs produce the best results, for whom, in what format, with what support (face to face, on line, texts, "apps for that," etc). How to target and construct a health and wellness program and then motivate consumer to action, compliance and commitment are skills still being refined in the healthcare industry. Analytics to understand all these dynamics will be critical to strong return on investment. Yet, in 2010 and 2011, fewer than 30% of healthcare payers have reported health and wellness as a key driver of analytics investment.
• Consumer contact management is among the most disconnected processes and technologies within most healthcare payer organizations. The current market environment is driving a new paradigm for consumer management – one that creates a consolidated program that supports consumer interactions at all stages of the healthcare and healthcare payer relationship. The consumer driven health plan model creates great linkages between sales, product and customer service. Value base healthcare and incentive payment programs now link customer service, administrative and care management interactions. Health and wellness programs and incentives require linkages and inbound and outbound interactions and new communications strategies for all consumer touch points. The healthcare payer needs to create relationships to manage health and disease starting with the sales process and at every possible touch point thereafter.

In the past few years, the mantra of integrated care management gave way to integrated healthcare management. The focus of the 2011 decade will expand the definition of CRM within the US healthcare payer market to include all consumer interactions –- sales, administrative, care, health, and wellness. And this expanded CRM strategy that includes investment in technologies, analytics and new channels to break down silos and to integrate and support all customer interactions, and to identify new opportunities for communication, efficiency, benefits, incentives, health, or care at each touch point.

Although there are a few healthcare organizations that are thinking strategically about ways to connect, reach and reach out to consumers better, for the most part, silo'd behavior still prevails – perhaps due to locked in technology legacy contracts or long standing legacy business practices. When ready, though, healthcare payers will find new investments and strategies among a number of technology companies to support a more integrated consumer management strategy. There have been announcements of initiatives attacking this problem by technology vendors over the past 12 months, including: Microsoft, Oracle, Pega, SAS, and Pitney Bowes. Expect new partnerships among CRM, care management communications and analytics vendors and new investment from technology vendors as this focus expands throughout 2011 and 2012.

For more about expected initial trends, directions and upcoming research, see the IDC Health Insights Report: US Healthcare Payer 2011 Top 10 Predictions: The Year of Disruption.

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