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Becoming a Digital Payer Series: A Deep Dive into 5 Key Attributes of a Digital Payer

5 Attributes of a Digital Health Payer

Rising consumer expectations, growing regulatory requirements, changing payment models, and new market opportunities are causing significant disruption across the health insurance marketplace. As a result, health plans are rethinking the traditional ways they do business and turning to digital technologies to help them respond.

HealthEdge offers health plans a digital foundation on which they can transform their organizations into digital payers to meet the demands of these new market dynamics more effectively.

But what does it mean to be a digital health payer? HealthEdge has identified five key attributes that drive digital payers, enabling them to rise above the competition and lead the way to better outcomes across the healthcare delivery system.

Digital health payers turn to technology to help them:

  1. Improve end-user and member centricity
  2. Achieve higher levels of quality
  3. Increase transparency
  4. Advance customer service
  5. Reduce transaction costs

In this five-part blog post series, we will dive deeper into each attribute, delivering resources, information, and insight to enable health plans to transform into digital health payers.

Let’s get started. First, we dive into the topic of improving end-user and member centricity.

Improving End-user and Member Centricity

Today’s economy is all about the experience. Whether the experience is in healthcare, retail, dining or entertainment, a heightened focus on the consumer experience is front and center for all business leaders. The evolution is being driven by consumers’ everyday experiences with digital giants like Amazon and Google. Consumers are experiencing new levels of simplicity, personalization, ease of communication, instant access to information, and seamless connectivity across every location, space, or device where they might seek to interact with the company.

Payers, providers, employers, pharmacies, and all healthcare stakeholders are taking notice and prioritizing the consumer experience. Some are even calling it the “digital front door.” But in healthcare, the member experience goes beyond protecting or generating revenue and satisfaction. It actually impacts member outcomes, which is at the core of what payers were originally created to do.

Payers have an opportunity to lead the way by putting the member at the center of their digital transformation. Now is the time for health plans to become attune to member needs and transform their interactions to improve the experience – and the outcomes for members and for their own organization’s success.

Member Challenges

Today, members navigate a hodgepodge of interactions to effectively understand, manage, and pay for their care. They research providers online and through multiple plan-provided sources, working to piecemeal information and understand which providers are in-network, deliver quality care, have availability, and are within their preferred geographic area.

When seeking care, members also struggle to get insight into pricing, coverage, and benefits, making it even more difficult to pick the right path. As a result, healthcare consumers often lack strong guidance to direct their care decisions, especially when multiple specialties or providers are involved.

After seeking care, understanding claims and payment processes becomes even more complex. Consumers often make payments through multiple channels and access points, creating frustration for the member as well as administrative burden on the health plan and provider.

Finding a Solution

To address the challenges members experience in today’s environment, it requires payers to have a sharp focus on the member, which is difficult to do when their many different, disparate systems cannot talk to each other. However, digital payers using modern systems can do this through three ways:

  • Deliver resources and information to coordinate care and navigate members through the care delivery system in a way that promotes better health
  • Implement technology systems that put the member first – easy to access, single point of information
  • Collaborate with other stakeholders to effectively integrate systems based on real-time data in a way that makes it easy for their care managers and members to navigate.

Considerations to Becoming Member-Centric

As health plans contemplate their digital transformation journeys, leaders should address the following questions:

  • What is the process members will follow to obtain information about their health, benefits, coverage, care plans, and payments? How can we make this process more seamless and intuitive?
  • Across each member touch point, how is information being shared? How can we make this information more accurate, up-to-date, and available in real-time across each point of access?
  • How are our processes, technology, and information improving health outcomes for consumers? What more can we do?

Get started with HealthEdge

HealthEdge enables payers to become digital payers by providing a digital foundation on which they can build a more consumer-centric approach to member and provider interactions. When digital payers implement a transformative digital strategy that puts the member and users first, everyone can more effectively navigate the complexities of the current health insurance landscape, while improving health outcomes and reducing the cost of care for everyone.

To learn more about how HealthEdge can help your organization become more end-user and member-centric, visit or email [email protected].