A look ahead: Keeping healthcare human
CONNECTED HEALTHCARE
A look ahead: Keeping healthcare human TTEC’s 5-year vision for connected healthcare
Prepared for
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A look ahead: Keeping healthcare human People-centered healthcare has graduated from platitude to mandate. It’s a strategy that can be operationalized at countless touchpoints and measured to deliver a solid return on investment. Organizations that re-think the healthcare operating environment today by retiring legacy tactics and replacing them with new people-centric processes and technology will emerge as the most-admired megastars of tomorrow. Five years from now, healthcare will look very different. Will you be ready?
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Our vision In the coming five years, we see a new healthcare ecosystem taking shape that puts people at the epicenter of everything. Processes and technology will revolve around the human, no longer burdened to navigate a tangled, disconnected system. Front- and back-office teams will carry out their daily tasks with a different world view than today. Trained to be empathetic. Supported by automation. Empowered by knowledge. Rewarded for performance that improves experiences. Data analytics used in creative new ways will reveal insights that inform decision-making, enabling leaders to deploy proactive strategies with confidence their investments will deliver on the promise. We help organizations sort through the maze of disjointed customer experiences (CX) to transform their healthcare operating environment across all touchpoints.
Lose the chaos. Keep healthcare human.
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Now and next: A gut check
Recent years brought market disruptions that are becoming increasingly more frequent and jolting, not unlike climate change’s effect on weather patterns. Now that consumers have experienced some degree of patient-centric care – delivered closer to home, with services tailored to their needs and schedules – their demands only rise as the speed of technology and expectations accelerates. Driving momentum for people-centered care: • Cost pressures continue to rise due to inflation, wage and labor issues, drug prices, and the overall costs of doing business.
By the numbers 7% Medical costs will increase 7% in 2024, continuing an upward trajectory from a low of 5.5% in 2022. 1 $504B global telehealth market, projected 2030, up from $143B in 2023 2 $146B global insurtech market, projected 2030, up from $5.5B in 2022 3
• Telehealth continues to grow and evolve into richer engagements, for both consumers and providers.
• The shift from fee-for-service to value-based care obliges organizations to manage operations more efficiently and to effectively coordinate with other groups, to ensure better health outcomes. • Innovations like AI and machine learning produce compelling use cases and consumers are more receptive than ever to technology’s role in their care. • Legislative changes affecting ACA marketplace access, the Medicaid and CHIP unwinding, Mental Health Parity Act, the Right to Try Act and even the FTC’s moves against hospital mergers make certain that uncertainty stays with us. • Expansion, consolidation, and new market entrants like insurtechs, exacerbate an already- fragmented market landscape that’s difficult for consumers to navigate.
Sources: 1) PwC ; 2) Fortune Business Insights ; 3) Zion Market Research
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Our approach We welcome the opportunity to provide Humana with an inside look to our perspectives — and prognostications — about how operating environments across the healthcare spectrum will look five years from now. As TTEC’s largest and most mature portfolio, our Healthcare Solutions team embraced this exercise to combine our strategic vision with market trends in a single, market-facing document. This undertaking challenged our team to take a step back to confirm our strategy, and update it as needed. Our mission is to improve the outcomes for our clients and the healthcare consumer and we took this challenge seriously. We’re in a unique position to approach the challenges in a holistic way that keeps healthcare human. • Team collaboration: To prepare this paper for Humana, we rallied our leaders as well as our front line to discuss and brainstorm, and wove in viewpoints from the front line to present a comprehensive, reality-based picture. • Our board: TTEC is fortunate to have Tracy Bahl , a luminary in the healthcare space, on our board of directors. Tracy provides invaluable insights through his experience in the marketplace and his laser focus on value-based reimbursement at Valtrius. • Outside TTEC: Healthcare is complicated, and we never assume that all we need to know resides with our own team and our own research. We interviewed our clients (payers and providers) to understand how they are thinking about changes to the operating environments due to the trends taking shape in their marketplace. We also interviewed the OEM for today’s leading technology solutions. As a preferred integrator for the Genesys platform, we felt it was important to speak with our partners at Genesys to validate our strategic vision presented here to Humana.
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What healthcare can’t look like in 5 years We’ve found that one of the best ways to predict macro-level trends is to eliminate scenarios that simply can’t work in the future. A firm understanding of what to avoid makes it clear where we need to go.
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We can’t ...
… just trust the system
… accept inefficiency
… sabotage our ability to leverage modern tools
… forget about the people
Source: 1) Policygenius
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Instead, put humans at the center of a connected experience
It starts with a digital front door that opens to a diverse suite of robust solutions, elegantly integrated and engineered to strip out traditional friction points. The building blocks of an optimized experience include:
Concierge-level care
Data analytics and personalization
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Enlightened curriculum and training
Enriched telehealth
Nearshore and offshore delivery options
Next-gen workforce/ staffing models
Automation/AI
Proactive outreach
Omnichannel engagement
Source: 1) AMA
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Connected healthcare: Our vision for 2028
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The U.S. healthcare system is besieged on all fronts by forces from within and beyond the ecosystem. While cultural and socioeconomic shifts, world events, and a fragile economy aggravate how care is delivered, its ever-rising cost, and inequity, there’s a host of other stressors and pressures that make for a chaotic experience for patients. Today: A healthcare system full of friction
That’s today. Not five years from now.
Escalating cost of healthcare delivery
Rapidly changing demographics
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Consumerization of healthcare
Seismic shift in the workforce
Rise of value-based care
Sources: 1) Peter G. Peterson foundation ; 2) U.S. Census Bureau; 3) Mercer; 4) McKinsey; 5) Medical Economics/Harris Poll; 6) EY 2021 Global Board Risk Survey; 7) American Hospital Association;
8) American Academy of Family Physicians (AAFP); 9) American Academy of Family Physicians (AAFP)
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From chaos to connectivity: How to keep healthcare human in the next 5 years
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Mitigate fragmentation across the patient experience The new operating environment of 2028 features a digital front door that opens to an integrated suite of solutions. Contact center health advocates shift to proactive mode to provide concierge-level assistance such as, “Looks like you’re due for a colonoscopy this year. May I schedule that procedure for you?”
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Case in point Fred and Mary are bowled over by the high-quality health plan experience they encounter. The elderly couple seeking a Medicare Advantage plan is assisted by a concierge-level adviser, who takes a personalized, multidimensional approach that strikes the right balance between the human touch and digital enablers.
Solutions • Conversational AI
• Analytics to drive tailored solutions and personalized interactions
• A central point of contact, or liaison, to represent the consumer and help navigate the healthcare network
See how it’s done
• Patient healthcare literacy
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2
Enable an expert, empathetic workforce The new operating environment of 2028 will strike a balance between talent, technology, and training initiatives to create a specialized healthcare advocate in the contact center. Artificial intelligence (AI) flags compassion fatigue and proactively offers resources to help healthcare advocates rebound and return to work with a healthy mindset.
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Case in point An anxious, young mother-to-be is alarmed to discover her trusted OB/GYN is retiring and won’t be available to deliver her first-born child. She calls her health plan and reaches a well- trained, empathetic, AI-assisted healthcare advocate who finds a qualified OB/GYN for her, schedules an appointment, and offers an array of resources to guide care throughout what’s expected to be a complicated pregnancy — all on one call.
Solutions • Enhanced curriculum and training to reduce the learning curve
• Geo-expansion enables more work outside the country
• Nearshore and offshore delivery
• FlexEX and Smart Seasonal
See how it’s done
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3
Respond to changing demographics and health equity dynamics The new operating environment of 2028 will incorporate an enlightened educational curriculum that helps healthcare advocates working in the contact center better understand and empathize with people from all walks of life and ages, whether they are from different cultural and racial backgrounds, disabled, or from communities marginalized in the past, such as low-income and rural areas.
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Case in point A trans man has grown accustomed to annual pap smear claim denials based on the gender “M” in his medical record. Data analytics and refined algorithms that flag and reconcile the discrepancy to override the gender-based rule, enable a person born as a woman who identifies as a man, to receive the care, respect, and coverage he deserves. A healthcare advocate assures the member he will no longer encounter such claim denials. When the two discover they are both fans of the same sports team, the member feels comfortable enough to disclose additional personal information that helps the advocate provide even better, more personalized support.
Solutions • AI-based bots for training, coaching • Role-playing exercises enable new hires to practice their skills in simulated interactions before moving to live customer calls • Feedback loop so high-performing practices can be replicated across the organization • NPS surveys, ongoing monitoring of CSAT and DSAT
See how it’s done
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4
Expand the use of value-based care
The new operating environment of 2028 will prioritize the value-based care delivery model. When providers move from fee-for-service to value-based delivery, they are incentivized to spend more time with patients in the preventive phase of care, which ultimately reduces the amount of time they need to spend on disease management. This will result in better patient health and engagement and lower cost to all. Patient by patient, cost can be removed while improving health outcomes, which will take cost out of the entire healthcare operating environment.
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Case in point An older patient with multiple chronic health conditions relies on her primary care physician to manage her health, provide preventative care, and coordinate care with other providers via a shared network. With visibility into all the healthcare benefits available to his patient through her health plan, the doctor encourages her to try out some wearables to monitor her conditions, leading her to take greater control of her health on a day-to-day basis. The VBC approach saves money for both patient and provider as well as the insurer, because the patient avoids unnecessary services thanks to her healthier lifestyle.
Solutions • AI-enabled back-office claims processing • Well-trained advocates with deep VBC understanding who can translate where needed to provider and patient care • Continued analytics/reporting for payers to quantify ROI and benefits of VBC to their organization
See how it’s done
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TTEC’s vision for conne Operating environment
Enable healthcare advocates to lead with empathy, personalization, and concierge-style support.
Ditch traditional workforce management models; they are too rigid for tomorrow’s workers. Incorporate flexible scheduling and Smart Seasonal models.
Optimize knowledge management, incorporating AI with a crawl-walk-run approach.
Apply AI and NLP across the entire lifecycle, from enrollment to retention.
Make sound decisions at the individual level based on deep analytics and insight.
Support employees to reduce burnout and associate abuse so they can increase productive engagement. Explore clinical capabilities with expert and licensed advocates to create seamless experiences.
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ected healthcare 2028 Healthier outcomes
Financial benefits: • Millions saved in operating costs • Lower cost per enrollment • Lower costs to serve
Operational benefits: • Higher conversion rates
• Increased digital channel adoption • Improved advocate productivity • Decreased handle times • Shorter wait times
Consumer benefits: • Seamless experiences • Less confusion and frustration • NPS improvements • CSAT increase
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Prepare now for a bright healthcare future
Preparing the workforce
Preparing the consumer
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Preparing operations
Preparing the technology
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Make the 2028 vision a reality It’s a big undertaking. Let’s work on it together. Contact TTEC Healthcare Solutions to get started.
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TTEC Holdings, Inc. (NASDAQ: TTEC) is a leading global CX (customer experience) technology and services innovator for AI-enabled digital CX solutions. The Company delivers leading CX technology and operational CX orchestration at scale through its proprietary cloud-based CXaaS (Customer Experience as a Service) platform. Serving iconic and disruptive brands, TTEC’s outcome-based solutions span the entire enterprise, touch every virtual interaction channel, and improve each step of the customer journey. Leveraging next gen digital and cognitive technology, the Company’s Digital business designs, builds, and operates omnichannel contact center technology, conversational messaging, CRM, automation (AI / ML and RPA), and analytics solutions. The Company’s Engage business delivers digital customer engagement, customer acquisition and growth, content moderation, fraud prevention, and data annotation solutions. Founded in 1982, the Company’s singular obsession with CX excellence has earned it leading client NPS scores across the globe. The Company’s 63,900 employees operate on six continents and bring technology and humanity together to deliver happy customers and differentiated business results. To learn more visit us at ttec.com . About TTEC
00692 10/23
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