Healthcare user experience: the moments of truth

“If you don’t know where you are going, you might wind up someplace else.”

-       Yogi Berra

Healthcare experience is like “fine wine”

Much of the articles and conferences addressing improvements to the healthcare user experience start from a premise that consumers arrive at every interaction with basically the same set of expectations, assumptions, and needs. Like a novice wine aficionado, they miss the fact that “fine wine” for one person may be Ripple to another.

Traditional healthcare delivery organizations struggle to “improve the patient experience” because often their improvement efforts are founded in tweaking existing workflows and experiences instead of understanding the user experience from the consumer’s point of view. 

The experience vs expertise calculation

When a consumer has a healthcare need, they make an intuitive calculation balancing their experience expectations vs the professional expertise they believe their condition warrants. How scary or familiar the healthcare need is for that individual drives their calculation.

We see the results in the marketplace, as retail, virtual and urgent care offerings have flooded the market and have been welcomed by consumers. Traditional primary care practices have seen their volumes of low acuity care dwindle. Consumers are making the rational calculation that low acuity conditions do not warrant the long waits, inconvenience and less than optimal user experiences often found in most primary care clinics.

Try as they might to stem this loss of simple, low-acuity encounters, the failure of incumbent, traditional healthcare delivery entities to evolve and keep pace with current user experience expectations has put their administration and leadership under financial stress. Their typical response strategy is to push staff to do more with less instead of backing up and asking what the consumer user experience expectations really are.

The moments that matter

The moments important to healthcare consumers are fairly straight forward. Consumers renew or enroll in their health insurance plan once per year. At that time they may need to shop for a new plan or choose from a couple of plans offered by their employer. They receive plan materials, which they may keep or recycle or forget about. Months may go by with no need to seek healthcare. Then suddenly they need to access care. How to find a doctor? What does my insurance cover? How much will I have to pay?

These healthcare moments of truth are opportunities for innovative companies to offer value and change the existing paradigm.

Here are a few of the moments of truth and the opportunities they afford to in traditional and start-up companies.

Choosing a plan: health insurance is confusing, even to those that work in the industry. Consumers prioritize plans that include their preferred doctors in-network and plans that cover their prescription drugs.

Opportunity: digital tools that help consumers navigate to the health insurance plan that meets their needs at the lowest annual cost will see broad adoption by consumers and in some cases by health insurance carriers and self-funded employers.

Planning for expenses: almost no one inside or outside the healthcare industrial complex can say for sure what the cost of an episode of care will cost. However, health insurance out-of-pocket costs are relatively straightforward to calculate for a specific plan and individual. However, every plan is different, so almost every consumer faces a different out-of-pocket cost for the same service based on their personal deductible and out-of-pocket maximum on the day the service is delivered.

Opportunity: while the out-of-pocket expense calculation is unique for each individual, the variables are known. A digital or AI tool that accesses plan benefit data and claims status to calculate deductible and out-of-pocket status in real time would create unique differentiation for an insurance carrier.

Getting help and information

Not surprisingly, many consumers rely on internet searches to find information they are looking for. Insurance companies struggle to keep their provider directories totally accurate since doctors move from clinic to clinic and open or close their panels to new patients. Health insurance websites are notorious for a poor user experience and difficulty in finding information sought.

Opportunity: navigation services – digital and analog – available in multiple languages have seen growth in recent years. Key to this opportunity is the ability to intake health insurance plan information from multiple carriers and serve up answers to consumers specific to their plan, doctor and personal claims status year to date.

What does this mean?

The healthcare user experience is like “fine wine” - one person’s great experience may be disappointing to another. Improvements to the healthcare consumer experience offer new business opportunities to non-traditional healthcare companies able to leverage digital and AI tools to fill in the experience gaps left by the incumbent provider organizations.

Starting with an understanding of the consumer’s unique healthcare need, their experience expectations, and the professional expertise they seek can uncover opportunities to add value and grow your business.

Copywrite 2itive 2024

2itive is a Portland based consultancy founded by Erik Goodfriend, offering a unique combination of market intelligence, knowledge of healthcare payment systems and creative business strategy insights. Feel free to contact us at info@2itive.com