Mass-Customizing Benefits for the Consumer Era in Healthcare

Rick Valentine
Managing Director of Business Intelligence Strategy
DST Health Solutions

Healthcare payers long have talked about mass-customized benefit designs. These plans would be tailored to the specific needs of individual consumers; for example, young adults who are healthy, active, and interested in a higher deductible, or older adults who lead sedentary lives, are at risk for health problems and prefer a lower deductible.

Historically, however, payers have lacked the technology to make mass-customized designs an affordable, practical reality.

That’s changing, and just in time for the changing healthcare market. Consumerism is sweeping healthcare today, compelling payers to find creative new ways to attract and retain individual consumers, as opposed to employer groups. Mass-customized designs are just what the consumer ordered.

Fortunately for payers, new technologies are arriving just in time.

Many payers have recently begun to adopt predictive tools to forecast future events, an advanced optimization tool can add a powerful new dimension: prescriptive analytics. In addition to making predictions, the tool’s prescriptive capabilities suggest decision options, helping payers take advantage of predictions. The tool identifies the best possible business decisions and their consequences – before the decisions are implemented.

Advanced optimization enables the payer to develop mass-customized benefit designs that provide the broadest possible coverage and the most attractive price points.

The tool can consider socioeconomic, demographic, and psychographic factors such as member income, lifestyle, beliefs, media preferences, and technology usage, helping you create benefit designs that are truly tailored and attractive to the consumer.

During enrollment, consumers can visit the payer’s member portal to design plans that meet their individual preferences and needs.

As consumerism gains momentum in healthcare, it’s time for payers to move toward individualized benefit designs. Advanced optimization enables you to make this a reality.

In future blogs, I’ll focus on the power of advanced optimization to help you achieve new efficiencies in bid preparation and formulary management.





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