Payer IT paradigm shift needed to support customer-centric approach

With health plans focusing their organizations more on customers, it’s critically important that we ensure IT applications and infrastructure are modernized to better collect, store, analyze and produce more specific customer information.

The IT implications are significant because plans’ administrative systems have historically focused on policy administration. While administrative systems are good at handling transactions, they lack the ability to provide in-depth integrative reporting for the new marketplace. Even plans that layer additional customer fields onto existing data models are merely scratching the surface of the data and capabilities needed to have a true impact on customers.

Legacy systems operated by most plans today only provide a static impression of customer behavior. It’s important to shift this internally focused paradigm to an externally focused, customer-centric one that incorporates analytics to a greater extent than we do today.

Customers’ expectations of their plan have changed — they want their plan to know them and their preferences, such as how and when they like to be contacted. They also want customer-specific responses, often in real time. Even using the term “customer” as opposed to “consumer” is important — “customer” shows personalization, customization and individual positive selection.

Plans need to start viewing their analytics in this same manner to provide full transparency in the complete lifecycle of their customers’ behaviors and activities. This transparency has helped retailers like Netflix and Amazon become experts in customer behavior.

I recommend some best practices plans should focus on to develop a robust and powerful customer analytics model that will:

  • Conduct data and analytics maturity assessments to determine roadmap/infrastructure.
  • Create a new, innovative data model designs to support new, customer-centric business.
  • Leverage a customer-centric data warehouse/data mart as the foundation.
  • Leverage innovative data technologies — cloud, mobility, etc. — for scalability and agility.

These steps mark the beginnings of a new kind of interaction with members. Taking advantage of these steps helps turn “members” into “customers”.

To read more about the IT paradigm shift needed to support this new approach, download our article “Payer IT paradigm shift needed to support customer-centric approach.”


About the authors

Rajiv Sood, Vice President, Optum

Rajiv SoodRajiv has nearly 25 years of hands-on U.S. and international health care and health insurance industry experience within both government and private sectors. Over his career, he has served in a variety of senior level capacities specifically advising the C-Suite and Boards of payers, providers, MGUs and others on policy, strategy, technology and operations within both primary insurance and risk/reinsurance domains.


Frederick W. Rook, PhD, Vice President, Optum

Fred RookFred has 25 years of experience in IT leadership in health care, insurance and financial service environments including being the CIO of a Fortune 500 Health Insurance company. He has provided IT services to global companies including strategic and operational IT planning, commercial software development and application development, including offshore development models. He has previously managed a commercial analytics/data warehouse business comprising over 500 analytics professionals.

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