Skip to main content

#Idea - ‘Suggest a Doctor’ - Improve Member’s Provider search experience


Why: Finding a healthcare provider is a painful exercise. Tools like ‘Find a Provider’ are useful, but still require a Member to spend considerable time to decide which doctor fits his needs well. Here is a blog I wrote that details ‘why’ 

What: A doctor recommendation tool that suggests / recommends doctors that fit our member’s needs, preferences and insurance plans.

How: We have information / data about what providers members choose (either PCPs or specialist in a PPO plan). We also have demographic data about each of our member and details of which providers are preferred based on the insurance plan they have. We also have clickstream data of how member searches to find a provider that works for him / her. This data can also be combined with Claims to determine which provider ended up visiting. Combining these sources and using ‘predictive analytics’ we can narrow down the list of providers that fit member’s requirements and present a list of suggested providers to help member’s provider search experience better.  

Over time, our tool will become better at suggesting doctors using past experience (which provider we had suggested, and which provider member ended up choosing). 

We can also make this ‘suggestion tool’ better if we are able to tap into provider review data (either from third party or from feedback we collect from our members).


Potential roadblocks:
We need to ensure that we remain compliant with all rules and regulations. Couple points to consider as mitigation of any compliance risks:
  • We may have to create an new entity separate it from our core business and ensure that we do not have conflicts of interest with our members
  • We may be able brand the tool, not as 'suggest a doctor', but as 'people like you, chose these doctors'. (Not sure if this is inline with how we should act as an insurance company, but helping people choose a doctor is the intent of this idea).





Labels:

Comments

Post a Comment

Popular posts from this blog

Role of complexity in ‘Keeping it Simple’

" It can scarcely be denied that the supreme goal of all theory is to make the irreducible basic elements as simple and as few as possible without having to surrender the adequate representation of a single datum of experience." – Albert Einstein It is not simple to ‘keep it simple’. Process of ‘Keeping it simple’ involves complexity. We need to accept that we cannot keep it simple for everyone involved. Simplifying one constituent would almost always make it a bit more complex for others involved.   However, ‘keeping it simple’ can work wonders when we consciously decide to make it simple for constituent that matters. For most Organizations, ‘keeping it simple’ for the ‘consumer’ is a good strategy. Most Organizations get this right, but they also need to understand that making   it simple for consumer would result into a more complex (or at least ‘changed’) business process or operating principles for other constituents. In this age, it will requir...
Post a Comment
Read more

How to go from ‘thought’ to ‘reality - Know you will be wrong

Most radical ideas are flawed. Know that you will be wrong and be open to letting go of an idea that you may have fallen in love with. Knowing and being comfortable with being wrong is essential to keep generating new ideas. Ask for feedback around why this idea won’t work and listen with the intent of trying to kill your own idea. If your flawed radical idea has caused a ‘perspective shift’ in experts in that fields, you have made progress.  For more such lessons,  click here.
Post a Comment
Read more

Things to remember when taking an idea from ‘thought’ to ‘reality’

Having an idea is an inspiring moment. You feel the excitement of being able to solve something or change something for better. You share your idea with everyone and they all encourage you to ‘Just go run with the ball’. And then the difficult part begins. Having an idea is just a tiny portion of ‘doing something new’.  It’s a lot of work to take an idea from conception to reality. It becomes even more difficult when what you are thinking about and excited about is radically changing the way something has been done or it is creating something people are not familiar about.  Other way to look at it is – if people are already familiar with it – it is not something that radically different. Here are a few things we should do while trying to take an idea from thought to reality: Be kind to yourself Be patient Be Comfortable with you Naivety Plan for best outcome Make yourself tolerable by the Organization Know you will be wrong
1 comment
Read more