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Meeting consumers on their terms

Learn how Optum can support your growth priorities.


The relationships between consumers and health organizations are transforming. 

COVID-19 has dramatically disrupted and accelerated the rate of change for consumer engagement expectations. It expanded acceptance of telehealth, remote monitoring and in-home services. It caused many consumers to reconsider the status quo even more broadly. They began questioning the need for their typical health services and thinking about whom they want to build a relationship with for their care. The pandemic also revealed how attitudes, environments, culture and preferences play into the consumer’s engagement with their health system and adherence to care plans.

New financial pressures — and the ambition to solve them — have accelerated a phenomenon that had already been in place for many years. Nontraditional organizations are moving into the market, attracting customers with ease and convenience. These new entrants have been unbundling the traditional health system’s control of the consumer and their health experience.

Centers for Medicare & Medicaid Services (CMS) is also having an impact. The Price Transparency Initiative requires health plans to disclose pricing. The goal is that consumers understand how much health services will cost before accepting services. This allows consumers to make price-conscious decisions before accepting services from their providers. The Interoperability and Patient Access final rule gives patients access to more of their claim and clinical information. 

Both regulations put more decision-making information into the hands of the consumer. Yet they are simply finite steps toward the continuing trend of consumer empowerment. COVID-19 expanded consumer choice in price and channel delivery. CMS has expanded consumer powers of decision-making.

Today’s health organizations are contending with broader competition and a more informed, sophisticated consumer. Eighty percent of consumers say they’d be willing to switch providers for convenience factors alone.1 And telemedicine isn’t going anywhere — 83% of patients expect to use telemedicine after the pandemic resolves.2

83% of patients expect to use telemedicine after the pandemic resolves


Organizations must understand and cater to the complete spectrum of consumer preferences — not just their health concerns. Engagement, cost containment and improved outcomes will depend on how well they do that. To earn consumers’ business, dollars and loyalty, leaders will need to understand how consumers think about their health, what they are willing to spend and how, and when and where they will engage. This is a much more consumer-driven approach than health organizations have traditionally prepared for.

Building consumer segmentation strategies

Earning this engagement requires a nuanced and detailed understanding of all consumers. Health leaders have a strong foundation to build on. To date, many have been combining clinical and claims data to gain a more holistic view of their consumers’ health behaviors. That data is rich but still incomplete. 

To build a comprehensive picture, it needs to be enhanced with insight about demographics, behaviors, trended projections based on future expectations and any barriers consumers face. Consider these questions to gauge whether you have a complete picture of your consumers:

  • Can you identify which consumers you are best suited to serve?
  • Do you know where they are spending their health dollars? 
  • Have they confirmed which of your services are most valuable to them?
  • Have you identified which services matter most to your desired consumers, and whether you provide them — or not?
  • Do they feel you are easy to access and affordable?
  • Do you understand why they may miss appointments or delay payments?
  • Have you examined their ZIP code to determine the social determinants of health (SDOH) prevalent in your population?
  • How can you create greater stickiness to your offerings?

A wide spectrum of individuals exists across any population. Each person is coping with different financial realities, health conditions and SDOH. One type of consumer may worry about the complicated state of health care and value direct, clear communication. Another may value excellent customer service and comprehensive coverage. Every consumer is different — with expectations about the services they receive. 

Leaders should acknowledge they can’t serve everyone equally well, and hone in on where they deliver the most value and to whom. Then consumer segmentation strategies can inform product development, guide channel redesign and prioritize outreach efforts.  

Develop a holistic understanding of your customer

To start the segmentation process, providers can group their existing information into meaningful categories. Next, layer on more sophisticated data and analytics to refine customer profiles. Then consider developing a listening platform that continually collects insight and sentiment from your website, call centers, staff, online reviews and social platforms. This information tells you why people choose your services and why they don’t. Collectively, these insights can help guide investments and decision-making.

As an example, investing in a “digital front door” can create a differentiated consumer experience. It also provides a clear and lasting competitive advantage. Digital enablement has not historically been an area where health organizations excel. But whoever owns the digital front door can guide the consumer throughout each health event and across their health journey. 

A digital front door could include consumer portals, online scheduling tools, prior authorization, upfront cost estimation and remote monitoring tools. It could aid compliance with CMS regulations, reduce cost, and offer consumers the ease and convenience they desire. 

These new digital offerings can meaningfully enhance customer interactions. But they are not a “silver bullet” by themselves. They need to be supported by systems and infrastructure so that they work seamlessly with other, non-digital channels to provide a simple, coordinated care experience.

Consumers want us to meet them on their own terms. They want to be engaged as individuals with unique needs and preferences — in terms of how they access, interact with and pay for their health care. Providers and health plans can work together to build a targeted and meaningful consumer experience that ensures greater loyalty and better health. By strengthening their data, aligning their goals and focusing their investments, they can maintain relevance and create new opportunities for transformation and growth.

Learn how Optum can support your growth priorities.