To avoid delivering disappointing member experiences, payers need to ensure the business, not IT, is leading these initiatives. In turn, the business must lead with in-depth strategy and design activities to ensure the digital capability meets actual member needs while creating business value.

Whereas business-led digital development follows a rigorous methodology that includes creating personas and journey maps and using outside-in analysis for examples of how other industries deliver similar solutions, IT-led development often starts with technology selection, and then fits processes to the technology’s capabilities. The business-led approach fully scopes out member needs first. These needs then drive the technology architecture design and technology selections so that the technology serves the business vision vs. defining it.

A large health plan we worked with took this approach to create new experiences for how brokers interact with members. We developed and designed personas, user journeys and eight future-state business processes before developing technology requirements.

4. Change funding mechanisms.

It’s accepted practice today to spend heavily on implementation while strategy and design efforts receive limited funds despite being prerequisites to successful outcomes. One organization we worked with was trying to build an industry-leading artificial intelligence model but lacked adequate budget to estimate ROI. Organizations must reallocate more budget to strategy and design efforts.

Advances in platform solutions that minimize customization needs support this funding shift. Organizations also must redefine how they identify OpEx and CapEx spend because many strategy and design efforts (e.g., journey maps, process models, business architecture, etc.) are critical to building required future capabilities and may be capitalized.

Our study revealed a number of immediate investment priorities for payers, including tools for estimating procedure costs, looking up benefits, searching for providers, finding plan options, reviews and features, checking on claims status, and calculating out-of-pocket expenses. But to realize high adoption and commensurate returns, payers must build these capabilities on a foundation of analytics and business-led strategy and design, followed by strong awareness campaigns.

By taking this approach, payers will set the stage for future member interactions that are more relational vs. transactional, such as health coaching, which will build loyalty and market share.

For more, read our report “Health Consumers Want Digital; It’s Time for Health Plans to Deliver,” produced in partnership with HFS Research.