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Business Strategy: An Architectural Strategy Driver for Payers — "Patient of One"

Business Strategy: An Architectural Strategy Driver for Payers — "Patient of One"This IDC Health Insights report examines the opportunity of payers to strategically and technically appreciate, respect, and optimize the concept of a consumer as a whole person, both member and patient. According to Jeff Rivkin, research director of Payer IT Strategies at IDC Health Insights, "Payers have disconnected from customers over time, separating the person from the transactional unit processed by the company. Payers separated the patient from his/her medical service via a claim, the subscriber from his/her care requirements via a generic one-size-fits-most plan from an employer, the patient from his/her diverse provider desires via a specified network, and the customer services desired via a call center script or Web site. Bill payment focus, mass marketing, internal departmental applications, and claims emphasis are now replaced with data sharing, consumer personalization, enterprise focus, and a partner-in-care mission. Successful payers will take holistic consumer approaches around the patient-of-one philosophy that unifies their prospect, network, administrative, and clinical strategies and technologies."

Please Note: Extended description available upon request.

IDC Health Insights Opinion
In This Study
Situation Overview
Bill Payment Has Been the Focus of Data Sharing Between Medical Facilities and Insurance, Not the Patient
Personalization Is Becoming Expected by Consumers
There Are Four Islands of Consumer Technology, Data, and Strategy in Payers
Insurance Is Migrating to Be a Collaborative Partner in Care
Adaptation to Patient-of-One Philosophy Is Required
The Approach
Loyalty or Retention "Prospect Target of One" Business Strategies
Assume Consumers Will Be Switching Out and Back; Eliminate "Renewal" Mindset
Separate Acquisition, Loyalty, and "Win Back" Campaigns
Personalize Product Offerings
Provider Network-of-One Business Strategies
Assume Any Consumer Service Source Can Be a "Provider"
Sponsor Virtual Care
Customer/Member Profile-of-One Business Strategies
Consider Lifetime Value and Illness Burden, and Manage Your Customer Relationship Accordingly
Value a Customer Over a Lifetime, Not Just per Subscription (Year)
Medical Profile-of-One Business Strategy
Understand the Evolving Standards of Medical Data Capture, Storage, and Exchange
Contrast the Data Categories in Medical Records to How a Payer Looks at a Patient
Future Outlook
Essential Guidance
Actions to Consider
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