Digital Front Doors Pt. 1 - Knock, Knock, Are You Keeping Up?

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Over the last two decades, consumer retail and technologies have reset consumer expectations and that wave has crashed over healthcare. Resoundingly. Healthcare organizations initially responded with consumer-oriented benefit products, self-service experiences, marketplaces and all manner of digital accompaniments. Providers and Pharma companies are following suit. As they evolve into consumer-centric and digitally-savvy organizations, so too does the landscape. The very definition of transparency, affordability, convenience and choice are also evolving.

One of these responses to this wave has been the Digital Front Door (DFD). In this blog installment, we will review the current state of DFDs - especially amongst Payers and Providers - and how they are managing to keep up. Or not.

The genesis of Digital Front Doors (DFDs)

The impact of changing consumer behavior is quite apparent. Examples include:

The DFD has been a tactical response to assuage growing consumer frustration with how healthcare companies do business and interact with consumers. If you think about the bevy of benefits and service lines any given Payer or Provider chooses to (or has to) offer, things can get very complicated. Couple this with service fragmentation because so many benefits and services are often out-sourced and bundled, and you have a lot of things a Digital Front Door could be.

Early responses from Payers

Payers were the first to respond. At Medullan, we were fortunate enough to be on the leading edge of delivering such a DFD for a national Health Plan looking to engage over 5M members with a single platform experience. Over the last several years, what we learned over the course of the program has been very valuable to understanding where we are today, what lessons can be carried forward, and how we would do things differently.

A few highlights:

  • Strength of leadership vision: Leadership made a concerted effort to transform the experience of its members starting with an established vision, robust segmentation, and key objectives and metrics that trickled down to every release planned for the DFD 

  • Service design commitment and infrastructure: A digital transformation program and methodology was established that ideated, validated, and implemented “surface-to-core” documentation that enabled Marketing, Member Services, IT and Operations, to support the creation and evolution of the DFD

  • Partner alignment and contracting: Much like other plans, numerous vendors were part of the DFD, and they were “onboarded” and included in roadmapping, planning, and contracting to align their goals, deliverables, and remuneration. Partners included: Nurse Line, PBM, Wellness, and Rewards.

  • Unified experience across assets: To curb service fragmentation and meet the specifications of the Service design, all digital experiences were required to adhere to a single brand umbrella and share a unified set of design patterns (e.g. navigation, messaging, channel follow up)

  • Focus on member engagement: Putting the member at the center is not easy, especially as an insurance business. But by focusing on member engagement, versus benefit management or cost reduction, a DFD is able to play “digital concierge”, with plenty of opportunities to create a win-win-win (satisfaction, benefit utilization, health outcomes)

  • Universal measurement of consumer journeys: The transformation would not have been complete without metrics, measures, and continuous improvement. A SAFe-like environment was supported by journey-level data and analytics to ensure activation, completion, and incentive management from digital behaviors. HEDIS measures, which continue to be of high import today, were mapped from this data.

Payers continue to struggle with much of the above, compounded by an explosion of apps, IoT offerings, CRM implementations, etc. The number of digital partners Healthcare enterprises identify as critical continues to rise. In fact, according to Gartner, Healthcare companies indicated they had 96 important digital partners 2 years ago, 123 today, and 179 are planned over the next two years. Typical performers across all industries cited they have only 38 important digital partners.

Provider deployments of DFDs

While Payers favored website and app experiences with distinct remits across those two channels, Providers have tended to leverage EHRs to offer web-based patient portals. This has yielded high Provider adoption rates, but mostly underwhelming to poor patient use rates. Will the same be for DFD apps?

To explore this, Medullan has begun an analysis of the DFD landscape for Providers, focused on apps.

Here are some of the early indications:

  • 100% of the top 50 ranked hospitals have a DFD

  • 95% of the largest 50 ranked hospitals have a DFD

  • Some hospitals have more than one DFD

Not surprisingly, most Provider DFDs focus on access and communication, where as Payer DFDs focus on engagement and appropriate benefit utilization:


DFD Blog 1-Chart


Fig: Most Common Features Encountered in Provider DFDs

While it makes sense for Providers to focus on access, that misses the opportunity to engage patients and reduce service fragmentation. In summary:

  • Middle of the pack apps are EHR based: Providers have a strong dependency on their EHR vendors, so the “middle of the pack” were all EHR-extended apps

  • Bottom of the pack apps are mostly homegrown efforts: 42% of the “first outing DFD apps” have low to poor ratings due to basic levels of functionality and quality

  • Top of the pack apps are a mix (and often part of a suite): The highest rated apps (3.3 to 5 star ratings) are a mix of homegrown or highly customized 3rd party apps and are simple and offer great connectivity across different tools and systems

Regardless of ratings, the adoption of these apps tell a familiar story: only three of these apps have crested 1 million downloads (with an average rating of 3.3 stars). Given downloads are only a small measure of engagement, that means the majority of these DFD apps are non-starters.

What’s next?

Although it’s impossible to foretell the future with 100% certainty, it appears as though the Payer DFD narrative may repeat itself with the Provider DFDs, especially with app expectations already well ahead of where they were a mere 5 years ago. New channels and form factors, such as wearables and Voice, are starting to outpace smartphone adoption. Patient portals remain a lost opportunity for many Providers when they should be “low hanging fruit”. Patient apps are barely able to elicit downloads, let alone continued use.

Patients, caregivers and members are no longer satisfied with access to a set of disparate and poorly connected health tools that support them in specific isolated instances of their health journey. They want an integrated and connected experience. They want to be treated like consumers, but with a level of empathy not found with their non-healthcare service providers. Need a trusted partner? Let's talk. 

In our next installment, we will look at how Payers and Providers can plan ahead of the next wave of consumer expectations by architecting their next DFD strategy to focus on engagement, without the need to “rip and replace” what has already been invested in. Access, communication, and self-service were not bad places to start. They were just too little, too late.

Written By:
Ibrar Ahmed
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