Health Insurance

Evolving The Member Journey

Healthcare reform. Vertical consolidation. Disruptive entrants. There is no shortage of forces creating uncertainty and risk for health insurers. However, the immediate risk comes from within: experiences that confuse, frustrate, and disenfranchise members. Health insurers have lagged other industries in experience — that gap now has consequence. Demand for alternative care and digital service models is intensifying, all while the baseline expectations of members are increasing. Doing nothing is not an option. Breaking down the bureaucratic, systemic, and technical barriers preventing the delivery of an orchestrated, personalized member experience has become critical to remaking the relationship — and crucial to the success of your firms. Forrester can help.

The Customer

Siloed data systems and limited VoC programs create a fragmented and inaccurate member view. This means you have little insight into the human beings you protect, barring the moments of duress. In these moments, not having the right information or service model creates frustrated members. There are two pieces to this challenge: 1) to get a deeper understanding of who your members are, how they act, and what they expect and 2) to make those insights an enterprise-wide asset so that teams are tuning decisions and operations in sync with members.

Map The Ecosystem

Mapping the member journey from end to end will uncover major weaknesses, disruption, and drop-offs in the member experience. Spending the time to modernize your infrastructure will set you up for evolution and expansion beyond the walls in which your data lives, satisfying members’ needs in their day-to-day lives. How you imagine and participate in these external ecosystems will decide your role with the member and your role in the market.

Design A Value Delivery System

Experience is the new battleground. Aligning data systems to establish a full member view is the first step. Layering in technology that ingests a myriad of complex data sets from internal and external sources — and then applying that data to deliver a far more valuable experience — will be a game-changing differentiator.

Scenario Planning

What will 2025 look like? Who will the key players be? What will you do in response to continued vertical consolidation? How will health insurers respond if the courts overturn the ACA? Scenario planning needs to put a stake in the ground as to what the future state will look like and act like. Anticipating tomorrow helps you clarify strategic options and stay ahead of external forces that can catch you flatfooted.

Health Insurance Insights


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VP, Research Director

Jeff Becker

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