Transforming Healthcare Payer Digital Experiences Series:

part one: Business Case for Digital Transformation

Executive Summary:

The Imperative of a Strategic Business Case in Digital Transformation in a rapidly evolving healthcare landscape, the catalyst for transformation transcends beyond immediate organizational needs to broader macro-level shifts. For payer organizations, a comprehensive business case rooted in strategic foresight is the cornerstone of success.

At Curate Partners, our expertise extends beyond consulting to partnering with you. We guide every phase of your digital transformation journey, from building the business case to solution implementation and beyond, with a commitment to excellence and deep industry expertise.
Aligning Stakeholders with a Robust Business Casedigital-first strategy health payer

In a world where healthcare payers previously triumphed by boasting the best medical networks, the tides are turning.Competitors, not necessarily with superior doctor networks but with a more robust digital-first strategy, are redefining the value proposition. Recognizing this shift, it is crucial to invest in technology and the customer journey to preserve and enhance strategic advantages.

Our business case development aligns vision and goals across your organization, engaging everyone from CFOs to CIOs, and from marketing to sales leaders. We focus on:

Our approach ensures we partner with you on the following key tracks:

  • Strategic Alignment: We synchronize transformation goals with broader organizational objectives.
  • Quantifiable Benefits: Our business cases highlight clear financial metrics, demonstrating tangible ROI, cost savings, and opportunities for revenue enhancement.
  • Risk Management: We identify and strategize on mitigating risks, providing a safety net for your investments.
  • Performance Metrics: We establish KPIs and operational benchmarks, allowing for real-time tracking and success measurement.

Why Curate Partners Stands Out:

  • Deep Healthcare Expertise: Our team brings rich experience and a profound understanding of the healthcare domain.
  • Customized Digital Strategies: We tailor strategies to meet the unique challenges of each client.
  • Collaborative Spirit: We partner with your teams for seamless integration and a sense of joint ownership.
  • Track Record of Success: Our history with various payer organizations demonstrates our expertise and commitment.
  • Long-term Partnership: We stay engaged beyond project completion to help navigate post-implementation challenges and opportunities.
Part 1: Building the Business Case and Setting Benchmarks

Deep Healthcare ExpertiseWe helped define clear objectives, key results (OKRs), and key performance indicators (KPIs), setting the stage for a foundational digital presence and a north star vision of comprehensive, omnichannel patient guidance and navigation.

The core strategy, elaborated further in the next part, was to shift members to digital channels, enhancing operational efficiency and member satisfaction. The business case centered on several key benefits: (shown in a template format to allow for easy reuse – replacing the key numerical values for your specific needs)

Going Paperless:

  • Objective: Transition X% of offline members to digital communication.
  • Projected Savings: Reducing paper usage by transitioning to digital communications could save approximately $N.NN per member annually, amounting to a potential saving of $N.NN million per year.

Real-Time Messaging:

  • Objective: Increase digital engagement for care navigation by X%.
  • Value Proposition: Enhanced member experience leading to a XX% increase in member satisfaction scores. This improvement in satisfaction correlates with a higher likelihood of member retention, potentially leading to a X% increase in member loyalty.

Online Search and Scheduling:

  • Objective: Achieve a XX% utilization rate for digital provider search and scheduling tools.
  • Operational Impact: Expected to reduce call center volume by XX%, resulting in an estimated annual cost saving of $N.N million based on reduced staffing and operational expenses.

Live Chat with Customer Support:

  • Objective: Implement a live chat feature and achieve a XX% utilization rate among members.
  • Cost-Benefit Analysis: Anticipated to decrease call handling time by XX%, leading to an annual saving of around $NNN,NNN in customer support costs.

Digital ID Cards and Reduction in Plastic Use:

  • Objective: Transition XX% of members to digital ID cards.
  • Environmental and Cost Impact: Reduction in plastic usage could lead to an annual saving of $NN,NNN, alongside enhancing the organization’s environmental sustainability image.

Uploading Pictures for Claims:

  • Objective: Enable and encourage XX% of members to use digital claims submission – take a picture of receipt and submit claim.
  • Operational Efficiency: Projected to reduce manual claims processing costs by XX%, leading to annual savings of approximately $NNN,NNN.

Digital Access to Claims Status and Other Plan Details:

  • Objective: Achieve a XX% adoption rate for digital claims status checks. Reduce inbound call volume by XX% through digital channel shift.
  • Customer Satisfaction and Cost Saving: Expected to improve customer satisfaction by XX% due to increased transparency and convenience, alongside reducing call center queries by XX%, leading to an additional $NNN,NNN annual savings.
  • Financial Impact: This reduction could potentially save $N.N million annually in call center operational costs.
  • Implementation Costs and ROI:
    • Estimated Implementation Cost: $N million, covering technology development, systems integration, marketing, and training.
    • Projected ROI: With the combined operational savings and anticipated revenue growth from increased member satisfaction and retention, the ROI was estimated at XXX% over three years
  • KPIs and Benchmarks:
    • Digital Adoption Rate: Monitor the percentage of members transitioning to digital channels.
    • Member Satisfaction Score (MSS): Measure the change in member satisfaction before and after digital adoption.
    • Operational Cost Savings: Track the reduction in operational costs associated with manual processes.
    • Call Volume Reduction: Monitor the decrease in call center traffic as a proxy for digital channel effectiveness.

Personalized Online Plan Guidance:

  • Objective: To increase plan comprehension by XX% among members through personalized online guidance.
  • Projected Benefit: Improvement in plan understanding could lead to a XX% decrease in plan-related customer inquiries.
  • Cost Savings: Potential savings of approximately $NNN,NNN annually in customer service operations.
  • Member Retention Impact: Enhanced understanding of plan benefits could lead to a X% increase in member retention annually, positively affecting revenue.

Online Cost Estimation Tool:

  • Objective: Implement an online tool providing transparent cost estimates for healthcare services, aiming to reduce billing disputes by XX%.
  • Projected Member Satisfaction Increase: Anticipated XX% improvement in member satisfaction due to better financial preparedness and transparency.
  • Operational Cost Reduction: Estimated annual savings of around $NNN,NNN from decreased billing disputes and administrative costs.
  • Enhanced Trust and Loyalty: Improved transparency in costs expected to strengthen member trust and loyalty to the brand.

Integration of Digital Telehealth Services:

  • Objective: Achieve a NN% increase in telehealth service utilization by integrating digital telehealth capabilities.
  • Response to Market Demand: A strategic move in response to the increased demand for remote healthcare services during the COVID-19 pandemic.
  • Revenue Potential: Potential to generate an additional $N million in annual revenue from increased service utilization.
  • Cost Efficiency: Expected reduction of XX% in non-urgent in-person visit costs, leading to an annual saving of about $NNN,NNN.
  • Member Convenience and Safety: Providing a safe, convenient alternative to in-person visits, enhancing the member experience.

Part 1 Conclusion:

With well-defined objectives and measurable KPIs, Curate Partners and the client’s team carved out a digital transformation roadmap that promises not only operational excellence but also strides towards a more member-focused, efficient, and sustainable future. This robust case underscored the transformative potential of digital channels in enhancing member engagement and operational efficiency, securing the investment for a multi-year transformation initiative. The subsequent section will delve into how Curate’s team, in conjunction with a cross-functional client team, delivered on these features and drove the ROI metrics home.

Part 2: Laying the Foundations: Building a Digital and CX Center of Excellence (COE)​

At the heart of any digital transformation lies the strategic vision that guides it. For this Curate Partners health payer client, the vision crystallized in the creation of a Digital and Customer Experience (CX) Center of Excellence (COE), a hub of innovation designed to bring to life the business case.

Download Part 2:
Initiation, Strategic Vision & CX - HCD