The Dawn of Digital Revolution in Healthcare. A Focus on Building Real-time Health Plan

Infosys commissioned Forrester Consulting to leverage Forrester research and Business Technographics® and Consumer Technographics® data to evaluate the changing role of payers, including the perceived challenges, drivers, and benefits of investment in a real-time health plan. The data and insights in this study are based on existing research findings from Forrester’s research on health insurers.

Healthcare payers are facing unprecedented volatility in their industry during the age of the customer (aka member). Payers’ historical business role — as a necessary financial intermediary between healthcare providers and the insurers’ plan members — has focused primarily on cost containment, with a strategy built on forcing down provider fees, narrowing and controlling provider networks, passing costs to their members via deductibles and copays, and coordinating care to ensure members are seen by high-quality, in-network providers in an appropriate care setting (i.e., not the emergency department). As a consequence, payers’ member engagement focuses on explaining, adjudicating, and managing coverage, claims, and premiums.

COVID-19 has changed healthcare forever. The pandemic has forced payers to accelerate their path to digital transformation from years to weeks. Seemingly overnight, member demand has shifted to convenient access through virtual care. The changes in today’s markets have extended to the payers — and therefore increased the need to invest in a comprehensive experience platform that leverages digital technology to guide members to the appropriate form of care, provide a great engagement experience, and remove barriers throughout the care journey.

A real-time health plan has become a strategic priority for payers; ensuring its support in the market will enable member engagement and retention.

Key Findings
  • Healthcare delivery is going digital. As a result, payers are preparing for digital transformation.
  • Good member experiences enabled by digital engagement platform and technology adoption drive better business outcomes for payers.
  • Antiquated processes and existing legacy systems are major barriers to payers’ transformations.

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