Healthcare payers have long prioritized member experience, investing significantly to improve customer satisfaction. However, their approach has often been incremental, rather than transformative, leading to a notable gap between customer expectations and the actual experience provided. Intensifying competition, regulatory pressures, and evolving consumer standards from industries such as retail and entertainment have heightened the urgency for payers to address this challenge promptly.

To bridge this gap, health plans are recognizing the need for embracing technologies such as analytics, automation, cloud, and AI. The emergence of generative AI presents an exciting opportunity to revolutionize member interactions, enabling health plans to make better decisions and deliver personalized healthcare solutions.

In this viewpoint, we examine the fundamental challenges impacting member experience within health plans, highlighting the importance of transformative strategies to address these issues. The report also explores the essential digital capabilities required for future member engagement, emphasizing the vital role of technology in meeting the evolving needs of healthcare consumers. Additionally, it examines the role of third-party providers in reshaping member experience and fostering a more connected, customized, and continuous member experience. Enterprises and providers across the healthcare industry can leverage this report to enhance their capabilities and thrive in a digitally enabled future, centered around the needs of members.

Scope

• Industry: healthcare
• Geography: global

Contents

In this report, we examine:

• Foundational customer experience issues in healthcare payer member experiences
• The defining pillars of next-generation member engagement strategy, employing the 3C approach
• Key digital capabilities vital for future-proofing member engagement
• Generative AI’s role in reshaping member experience
• Third-party providers’ potential contribution in facilitating member journey transformation

Membership(s)

Healthcare Payer and Provider Business Process

Outsourcing Excellence