3 Ways Healthcare Engagement Models Differ from Other Industries

Austin Ridgeway, Director, HGS Healthcare

Over the past couple of years, there has been a lot of industry buzz about what retail can teach healthcare about engagement strategies. Now it’s time to walk the talk, with many watching and learning from disruption like the up-and-coming Berkshire-Amazon-JP Morgan venture. Healthcare has, undoubtedly, made B2C strides toward 24/7 optimized experience—from nurse triage to CRM and analytical PHM data collection. Both payers and providers are more proactively tracking member and patient interactions to build intelligence for future interactions. Today, data collected is building on previous elements, fostering a holistic portrait of healthcare consumers, creating the foundation for predictive intent, and providing a more effortless experience.


Leaning heavily on these new strategies, healthcare is catching up to retail’s recent disrupters—from the digital convenience to personalization. It’s important to remember, however, that the road to engagement is not an easy one for healthcare. The uberification of healthcare metaphor notwithstanding, retail-to-healthcare engagement comparison is far from an apples-to-apples scenario. There are key differences between other industries and healthcare organizations, which have to navigate these market complexities:

1. More stringent compliance—When it comes to protecting member/patient/customer, and partner data, as well as storing it as securely, healthcare carries a much heavier risk and burden than most other industries. Further to this point, the cost of attaining compliance has steadily grown over the past few years, rising 43% from 2011 to 2017, according to a recent Ponemon report. Notably, the most heavily regulated industries, including healthcare, show a 106% increase in compliance costs for that same time period. At the top of the list for healthcare is the heavyweight Health Insurance Portability and Accountability Act (HIPAA), which changes daily with the onset of telemedicine and wearable devices that store protected health information (PHI). Undeniably, the healthcare compliance list is long, and a moving target. With all of these state and federally driven mandates, payers and providers know that even the smallest mistake can result in sanctions by the government, resulting in high costs, oversight, and extensive auditing. So, while functionally, other industries focus on certification and compliance, healthcare has to abide by a broader pool of more stringent regulations.

How BPOs can help: In the case of credible healthcare BPO organizations with reach and a diverse client base, they not only have a practical comprehension of the broader federal regulations but also benefit from the granular knowledge of state-driven certification requirements and understand the implications of conforming to these regulations. As expert problem solvers, they have the best exposure to understanding of the nuances of regulations and how they can affect business from an end-to-end perspective. A trusted BPO partner can deliver payers and providers a core service focus to commit the majority of resources to achieving business objectives. And the global reach of these service providers allows for rightshoring models that ensure that compliance standards are met while still providing cost and operational optimization, with implementation of new tools such as RPA.

2. Multiple customers—If the “customer is always right,” then who is the customer in healthcare? It’s actually not so clearly defined. Ask any supplier, and they may question whether they serve physicians, patients, hospitals, or insurers. Healthcare payers and providers have many users and influencers that they have to take into consideration across all operations. Payers aim to engage and satisfy members, providers, and potentially other stakeholders like third-party administrators. Providers answer to patients, payers, and other parties who have a stake in their success. Unlike retail and other industries, the healthcare industry presents a complex lifecycle of stakeholders with financial impacts. These parties are all influencers of market position, image and, ultimately, success. It’s essential to appeal to and appease these critical stakeholders, to close the loop between all parties in order to maintain this delicate balance.

How BPOs can help: BPOs can help to address these market challenges, as the right partner will have holistic healthcare lifecycle management expertise that builds long-term relationships to engage and offer exceptional service execution to your members, patients, and other relevant stakeholders. These outsourcing partners typically have a capability set that expands across numerous functional areas within payer and provider organizations. BPOs with a consultative approach will provide healthcare organizations the abilities to manage the expectations of all of the influencers relevant to the business, from voice to back-office operations. This understanding of upstream and downstream impacts will also assist with driving efficiencies and cost-saving opportunities. Ultimately, as a virtual extension of healthcare client operations, these partners will carry the customer-centric solution thinking that has led other industries to CX success.

3. Internal silo-ization of these orgs–Keeping in mind the bureaucratic and complex nature of healthcare processes, there can be organizational silo-ization that occurs within operational business units. Take, for example, internal decision making for a health plan’s Provider Engagement, which could roll up to another leader than the one that owns Member Engagement. In this classic example, there can be disconnects, causing higher costs and other operational inefficiencies.

How BPOs can help: Considerable advantage will be found with a BPO partner that has end-to-end understandings and capabilities across the entire healthcare ecosystem. These service providers, like HGS, are experts at centralizing operations to ensure consistency across all operating units and offer exceptional experience and improved outcomes on behalf of their clients.

Ultimately, to navigate these unique challenges and finally deliver the customer experience found in other buying scenarios, healthcare will increasingly look to the essential accelerators. Data analytics, RPA, AI, and machine learning are key enablers to healthcare transformation —from the way physicians are educated and practice care to how payers support care delivery. With proven success deploying this innovation, along with customer care learnings from more mature industries, BPOs can help healthcare clients to pave the way to truly improved customer, member, and patient experience.

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