Healthcare organizations are innovating and adapting faster than ever to stay competitive. The drastic shift in market demand and heightened consumer expectations caused by the pandemic has forced changes in healthcare providers and payers.
For example, two years ago, virtual care and telehealth services were rarely provided by providers or covered by payers. Today, telehealth services are common, and payer reimbursement is routine, as consumers demanded in the early months of 2020, and providers and payers responded.
Likewise, today’s healthcare consumers are no longer willing to tolerate poor customer support.They need self-service, fast problem resolution, and multiple options for support channels—from two vendors and payer. The consumer revolution that transformed retail, finance, entertainment, and other industries also applies to healthcare.
Health plan members now judge payers based on every interaction and touchpoint throughout their journey. These members want to interact with the health organization through the channel of their choice — whether it’s a phone call, text message, email or virtual assistant — anytime and anywhere. This trend of increasing consumer choice and empowerment has been bubbling under the surface in recent years, and the pandemic has only accelerated the process.
More and more health insurers are paying attention.Nearly a third (32%) of commercial health plan members said in JD Power polls They connected with their health plan via the web, mobile app or text message in the past year, the highest percentage ever.
“The past year has proven beyond doubt that the effective use of digital channels can increase customer engagement, build trust and boost brand advocacy,” said James Beem, Managing Director, Global Healthcare Intelligence at JD Power. However, Beem said the plan “has a long way to go to deliver consistently strong customer engagement across all of its member groups.”
Despite recent progress, health insurance remains one of the lowest rated industries in terms of consumer satisfaction, according to JD Power. The good news for wellness programs is that both the demand and availability of modern customer support platforms present an excellent opportunity to increase member engagement and brand loyalty.
A member engagement management platform powered by artificial intelligence (AI) and automation enables payers to offer members a synchronized, personalised and convenient experience – similar to what they get in more consumer-friendly industries such as online retail . This communication and information hub provides payers with a strong competitive advantage.
A differentiated and superior member experience can deliver great value to payers. Here are three ways health insurers can achieve this:
- Provide a unified member journey
Providing members with a wide variety of digital engagement tools is critical for payers to compete successfully in the age of consumer empowerment. But providing a range of different point solutions is not enough. Mobile apps, online portals, messaging apps, and call centers must be tightly integrated so that members can easily transition from one to the other without repeating requests or providing the same information over and over.
For example, a member might initiate a query on the payer’s website from their home computer in the morning, then try to follow up with a mobile app while out for lunch. Payers must ensure that information provided to the website from a home computer is captured and available through the member’s smartphone app. Otherwise, frustrated members have to start from scratch. For members who need regular or frequent access to their health plan due to ongoing care or chronic disease management, constant barriers and dead ends may prompt them to switch to another health plan.
To coordinate the member journey, many large payers are deploying a platform to manage all interactions — voice or digital. These platforms serve as command centers for health plan member interactions by enabling omnichannel digital engagement. Such platforms can coordinate responses to member questions and requests through the customer’s preferred channels, including through live agents.
A streamlined, cloud-native platform that integrates with CRM and enables cross-channel support can accelerate problem resolution, improve member experience, and increase brand value.
- Schedule member outreach
The healthcare industry has long lagged other industries in adopting technology. Communication between payers and members is a clear example. Typically, these include 1) one-way outbound communications (mail or email) for information about changes to payments or benefits, and 2) inbound requests for members to answer questions or raise concerns. Patient inquiries may come from phone, email, text, patient portal or mobile app.
In addition to unifying the member journey, a platform that manages all voice and digital interactions can transform the ability of payers to proactively engage members in conversations by leveraging the same digital channels that members use and love. It’s important, though, that payers don’t use these digital channels to send the equivalent of spam to members. Instead, payers must customize content for each member. This can be accomplished through event-based management software that can segment member groups based on highly specific data points such as age, health, location, and channel preferences.
Payers must also take full advantage of the capabilities of interactive digital channels such as chat and texting, allowing them to engage in real-time conversations and support sessions with members. For payers using chatbots, natural language processing (NLP) capabilities are necessary to accurately capture medical terms and avoid friction.
Finally, human agents must seamlessly support automated interactions if required. As robotics has become impressive, its ability to effectively solve problems remains limited. For interactions that require escalation or human intervention, intelligent routing capabilities can ease member frustration and empower online customer service staff to provide better support.
- Drive higher quality ratings
While member acquisition and retention will continue to be seen as a tangible measure of success, more payers are citing member satisfaction itself as a viable performance indicator—just in time for changes in the Centers for Medicare and Medicaid Services (CMS) , which places more emphasis on customer experience metrics when determining the CMS star rating for a payer’s Medicare Advantage (MA) plan.
According to consulting firm McKinsey, the weight of these customer experience metrics will increase from 32% of the overall rating weight in 2020 to an estimated 57% of the rating in 2023 predictEarning and maintaining high star ratings is critical to the success of the MA program, which McKinsey calls “the fastest growing line of business among many health programs.” A platform for managing interactions may be the key to a health plan’s ability to maximize the ability to pay for MA performance.
Rapidly changing member attitudes and preferences about how they participate in their health plans are forcing payers to grow or risk membership churn. Cloud-native technology platforms that allow payers to drive participation on membership terms will help them retain and grow their business.
Photo: shylendrahoode, Getty Images
