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The Uberization of American Health Care: Why We Need a Disruptive Model

Anand Natampalli and Daniel A. Schulte

Few examples highlight the differences between the analog and digital worlds as traditional taxi cabs vs. the ride-sharing company Uber.

In most cities, hailing a taxi means stepping out to the curb and then hoping a driver stops. You take whatever you get, then waste time paying by cash or credit card. It is just basic service, with no concern about you will ever use that taxi— or even that company—again.

Contrast that analog experience with the digital experience of Uber. You will not stand in the rain trying to flag down a car. Instead, you will use your smartphone to view Uber drivers in your area via a mobile app, select a car and driver, and set a pickup location. You can use your smartphone to track when the car will arrive; you can even read user reviews about your driver. The driver’s personal vehicle is clean and well-kept. And when you reach your destination the mobile app automatically charges the credit card you chose on your profile. Everything about the experience makes it clear that Uber appreciates your business and wants you back.

Similar changes are now occurring in healthcare, thanks in large part to the impact the Affordable Care Act (ACA) has in making health insurance available to millions of Americans. Before the ACA became law, health plans relied on a low-tech, employer-centric model of operation that all but removed captive members from the equation and traditionally focused on the distribution of risk. Little effort was made to develop strategies and invest in technology to digitally engage consumers.

What does the new marketplace look like? A critical aspect of engaging members and patients is delivering a unified, seamless experience across the channels or devices of the members’ choice, be it via smartphone, laptop, landline, email, or online chat.

Consider what a unified, digitally-enabled member experience might entail:

A 10-year-old boy from Illinois hurts his knee during a vacation in California. His mother logs in to the mobile app of the family’s health plan using her smartphone. The app identifies her location and displays all of the in-network urgent care centers, hospitals and physicians nearby, noting which are affiliated with her insurance plan, current wait times, the cost of each visit and how much of the family’s deductible has been met year-to-date.

With one click she is able to see member-generated physician ratings of the medical staff and overall satisfaction ratings for each care setting. Given two seemingly good provider options nearby, she decides to contact the insurer or provider from within the mobile app for more information.

The payer’s information system recognizes the family has been loyal members for five years, so it automatically routes her call to the premier customer service team. Informed that the wait time to speak to an agent is only two minutes, she elects to stay on the line. When the agent answers, he has information about her family’s plan, health history and preferences in front of him. He quickly answers her question and she heads off to the urgent care center with no anxieties about her insurance coverage. Similarly, the conversation can be had with a provider’s nurse triage line, to assure the mother of the availability of the right level of care when she needs it.

This is a very different experience than many members have had with insurance companies and providers in the past, but it represents the level of convenience and service consumers have come to expect in markets ruled by the consumer experience across the economy. As healthcare consumers with freedom of choice become less tied to their health insurer and more knowledgeable about their provider options, maintaining member loyalty becomes a strategic imperative.

Anand Natampalli, MBA, is Vice President, Global Business Development, for HGS, a provider of end-to-end business process services for numerous Fortune 100 health insurance companies and large provider organizations. He can be reached at anandmn@teamhgs.com.

Daniel A. Schulte, MBA, CHFP, is Senior Vice President, Provider Healthcare, for HGS, and is responsible for Operations and Client Development of all services HGS delivers to providers of healthcare, across the full spectrum of healthcare. He can be reached at daniel.schulte@teamhgs.com.

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