Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.



The Member-Centric Virtual Service Model

    Core member preferences are clear: members want health plans to offer them a convenient experience—from appointment availability and location, to parking and mobile interfaces—and affordable care, with known, specific costs.

    But from confusing policy terms to unreliable coverage information, plans are falling short of consumer demands. As a result of this service gap, new entrants are offering members what they want: clear next steps and obvious prices.

    Threatened by these new entrants, health plans want to improve their virtual interactions with members through phone, email, and web services, so that they can guide them to appropriate care. But these interactions rely on members to take the first step to enlist the plan’s help at the appropriate time—a rare occurrence.

    Rather than rely on this reactive service model, plans must build their virtual service to immediately demonstrate how plans will deliver on member priorities. Read this report to learn four service hallmarks that plans should proactively prove to their customers, from personal relevance of any services promising convenience to the predictability of care costs.

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