How we’re meeting member demands for digital personalization today and tomorrow

From recommended products to curated playlists, consumers now expect personalized experiences that match the increasing sophistication of retail or streaming giants like Amazon, Spotify and Netflix.   

How can we help ensure employee and health plan member experiences meet these expectations?

As Prime Therapeutics’ Chief Operating Officer, I spend a lot of time reflecting on our company focus to provide each person with the right medicine at the right place and in the most cost-effective way. Digital personalization opens a world of opportunities to help us achieve this goal. We can offer proactive interventions or tailor recommend patient treatment and experiences based on an individuals’ demographics, location, behaviors, overall health status and medical condition, values and more. 

Doing so requires the right tools and processes. We live in a data-dense world and organizations are increasingly turning to advanced analytics and artificial intelligence programs to help turn raw data into insights that drive improved customer experiences.

Prime is in a unique position to accomplish this. Our partnership with 19 Blue Cross Blue Shield plans across the country provides access to both medical and pharmacy data giving us a more complete view of the member experience that we can then leverage to benefit patient outcomes.  

One of the ways we’ve brought this to life is investing in a robust data infrastructure, built around the following operating principles:  

• Clean, organized data. Having verifiable data from multiple sources is the foundation for our ability to share data, analyze it and apply machine learnings.
   
• A process to understand and anticipate member needs and preferences. Reviewing customer data helps us identify trends and anticipate issues so we can offer timely services and solutions. We also review customer communication preferences to ensure that we’re reaching out to them in a way that is convenient and comfortable.
   
• Partnership with third-party vendors. 
   
• Collaboration across internal teams. Investing in digital personalization capabilities can be time consuming and complicated within an organization. Partnering with compliance, privacy and IT security teams is critical to helping ensure data is being collected, analyzed and shared in a responsible manner. 

Creating a solid data collection infrastructure is just the first step. Digital personalization’s success relies on connecting data into real-life outcomes or improved experiences for our customers. Having a complete view of the member experience allows us to tailor digital experiences to where the member is in their overarching care journey.

For example, with our Real-Time Benefit Check product, members can see personalized benefit information that helps them understand the cost of their prescriptions according to their plan in real time and make choices that work for them. All alternate drug and pharmacy/network suggestions are member-specific, based on the members benefit plan, formulary, network and accumulator balance at that point in time.  

This helps promote cost transparency and reduces the overall cost of prescription medicines for members and plans. In 2021, Real-Time Benefit Check helped members and plans save $7.8 million across 6,800 prescriptions.  

As the demand for personalization increases across all industries, we have an opportunity to better anticipate member needs in their care journey and enable more proactive outreach. This may look like:  

• Member-driven experiences: Members will continue to want to design their own digital experience, including how they want to be communicated with and how information is organized.
   
• Shifts away from episodic care model: With increasing sophistication in analytics and communication, members and patients may not require traditional episodic or intervention-based visits to providers. Instead, with remote monitoring devices and patient-reported outcomes alerting providers to needed intervention and modifications, people may choose to broadly manage their care outside of the traditional delivery setting. 

• Customized care recommendations based on health history: Much like retailers can use data to point shoppers to certain preferred items, we can review a member’s health history, past healthcare patterns and preferences around cost and convenience to offer suggested plan selections that fit their needs and values.

Digital personalization is a fast-growing area that can lead to huge opportunities for plans and members alike. As we’ve seen firsthand at Prime, leveraging data, advanced analytics and digital tools to deliver hyper-personalized experiences will help us shift to a more meaningful, ongoing relationship with members that simplifies and improves their experience and outcomes, while reducing the total cost of care.