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The future of healthcare products and benefits is digital

  • Insight
  • August 15, 2024

A three-part framework for payers to help transform products and benefits: Define, store, operationalize

Payers are in a race to win over consumers through greater personalization of healthcare products and benefits. A sound strategy can enable payers to help members navigate to the appropriate solution at the ideal moment of care through the channel that the member prefers — whether mobile, web, AI-enabled chatbot or another.

To illustrate the potential of such a strategy, imagine having an AI-enabled smart recommendation engine that can determine the ideal product and benefit packages for a member based on need, historic usage and projected usage. It could then turn that into a pre-configured (not customized) solution that can flow seamlessly from the point of purchase into an operational system without manual intervention.

Creating such a future calls for collaboration — among finance, tech and operations leaders — to create a digital transformation of health plan product data. This digital transformation holds the potential to overcome the challenges payers often face in sales, benefit configuration, reporting, service and billing. These challenges in turn impact health plan members and employers.

The future of health plan products is digital

PwC’s analysis of the impact of modern digital product and benefit capabilities shows that meaningful gains can be found across functions.

From systematizing data, improving data quality and data exchange from product to downstream systems, as well as reducing rework.

Improved reporting, automation of regulatory documents, elimination of cross-departmental inefficiencies stemming from inconsistent definitions of what constitutes a product, and benefit configuration.

Standardization and consistency of regulatory document filings like summaries of benefits coverage and annual notices of change.

Significant reductions in the time it takes to develop and deploy a product from ideation to sales to help operationalization and reporting.

Gains from flexible and personalized offerings both to help acquire new customers and to retain existing customers, as well as increased transparency making it easier to do business with payers through more efficient benefit setup and enrollment.

For payers, it’s not merely about keeping pace but taking the initiative to use the power of data analytics and digital innovation to help deliver tailored, efficient and easily accessible health products.

The future of health product design is focused highly towards personalized and adaptable plans that can cater to specific local network demands and encourage greater member involvement in health management. There’s also an amplified increased focus on mental health and well-being, recognizing the need for support as society continues to recover from the pandemic. Further, the evolving workforce structure will require multi-tiered benefit packages for part-time and gig workers alongside full-time staff. Innovative supplemental benefits are also needed to better address social determinants of health with a dynamic, iterative approach to product design.

A three-part framework to help transform products and benefits: Define, store, operationalize

A digital transformation of product data depends on implementing a referenceable single source of truth for product and benefit data, stronger governance to clean data, and leveraging of application programming interface (API) integrations and automations for real-time data sharing and reduction of manual workloads.

To successfully undertake a product and benefit transformation, PwC helps clients define, store and operationalize the framework. This framework is more effective when used in conjunction with a clear vision that helps drive value through increased speed to market, improved operational efficiency and ease of access.

The initial phase involves crafting a dynamic product taxonomy that can be consistently applied broadly across the enterprise for government and commercial lines of business. This taxonomy should clearly distinguish core products from additional value-added and ancillary offerings. Moreover, a holistic set of data attributes should be established for each product type (medical, dental, vision, add-ons, etc.) to gain clarity and uniformity across the lifecycle. Alignment on a common definition of product for the enterprise helps enable the taxonomy so they can thoroughly capture the offerings sold and serviced to their customers.

In the storage phase, it’s essential to overhaul existing systems to store product data more effectively and to better enable streamlined downstream data usage. The goal is to transition from traditional form and document management to a more sophisticated product data management framework. Selecting a strategic fit from available product solutions on the market can be crucial. The selected solution should be tightly integrated with sales platforms and any redundant solutions should be rationalized to help avoid duplication and inefficiency.

To operationalize, it’s vital to implement end-to-end governance for both the product taxonomy and the product management platform solution. This will involve defining clear ownership and establishing governance bodies and processes for the entire life cycle of product data. Teams should be identified, engaged and trained on the changes to facilitate smoother adoption. The rollout should prioritize key consumers, such as benefit configuration process teams, to demonstrate the immediate benefits of the integrated product data.

In the near term, payers can deploy product and benefit solutions using advanced analytics and GenAI to create more customized and dynamic products, such as wellness programs, digital health tools and value-based incentives, which can adapt to the changing needs and behaviors of customers. These emerging technologies can also improve pricing and risk models by factoring in customer preferences, health outcomes and social determinants of health. Moreover, health plans can use these technologies to streamline distribution and customer service channels by offering more convenient and seamless access to information, enrollment, claims and support through online platforms, chatbots and voice assistants.

Andrew Furman, Emily Graham and David Harvey contributed to this article.

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Christopher Joyce

Principal, PwC US

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