Transforming the Experience of Health Plan Members

The bad news: Health insurance is one of the lowest rated industries for consumer satisfaction. And the good thing: New customer support platforms could give insurers a chance to boost member engagement and brand loyalty.

The disruptive events of the past 18 months have forced healthcare organizations to innovate and adapt in response to changing market needs and consumer expectations. Today’s healthcare consumers not only want virtual healthcare and telehealth services, they also expect radically convenient customer support – from providers. and payers – through the channels of their choice.

Healthcare plan members now judge payers based on every interaction and point of contact along their journey. These members expect multi-channel options to interact with healthcare organizations where, when and how they want. The pandemic has only accelerated a trend of increasing consumer choice and empowerment that has long been apparent.

Some payers get the message. Almost one in 3 (32%) commercial health plan members said in a new JD Power survey that they had logged into their health plan in the past year via the web, a mobile application or text message, the highest percentage ever recorded.

“While many plans show tremendous progress in delivering their members during a very volatile and stressful time, they still have a long way to go when it comes to delivering consistently high levels of customer engagement across the board. all segments of their member populations, ”said James Beem, Managing Director, Global Healthcare Intelligence at JD Power.

Indeed, health insurance remains one of the lowest-rated industries in terms of consumer satisfaction, writes the research firm. The good news for healthcare plans is that the demand and availability of modern customer support platforms provide a great opportunity to build member engagement and brand loyalty.

A member interaction management platform, powered by artificial intelligence (AI) and automation, enables payers to provide members with a synchronized, personalized and convenient experience similar to what they get in industries more user-friendly such as online retail. This type of communication and information center can give payers a strong competitive differentiator.

Below are three ways a differentiated (and superior) member experience can deliver value for payers.

1. Unify the member path

Healthcare consumers get what they want: a wide variety of digital engagement tools in the form of mobile apps, online portals, chatbots, and other technologies. But these tools are typically so poorly integrated (or not integrated at all) that they become confusing and disjointed for Medicare members.

Given this wide array of platforms and channels used by payers to automate interactions or support member self-service, it’s no surprise that these one-off solutions make it difficult for members to navigate. the system and get the right information when they need it. For members who require regular or frequent contact with their health plan due to episodes of continuing care or chronic disease management, constant roadblocks and dead ends could lead them to a other health plan.

Major payers are starting to use cloud-native contact centers to orchestrate member journeys. These platforms serve as a command center for healthcare plan member interactions supporting omnichannel digital engagement. These platforms can coordinate responses to member questions and requests through the channel preferred by the customer, including through a live agent.

A streamlined platform that integrates with EHRs and CRMs and enables multi-channel support can accelerate resolution time, improve the member experience, and increase brand value.

2. Orchestrate the awareness of members of the health plan

The healthcare industry has a well-deserved reputation for the slow adoption of technology. Perhaps the most obvious example would be traditional payor-member communications. These typically consist of 1) one-way outgoing communication information (mail or email) regarding changes in payments or benefits, and 2) incoming requests from members to answer questions or raise concerns. . Patient queries can come from phone calls, emails, text messages, patient portals or mobile apps.

Just as cloud-native contact center platforms can unify the member journey, they can also transform the ability of payers to proactively engage with members by leveraging the same digital channels that members use and prefer. .

However, using these digital channels to bombard members with the equivalent of spam would be misguided and doomed to failure. Rather, payers must tailor content to each member. This can be done through event-based management software that can segment member populations based on very specific data points such as age, health status, location, and channel preference.

It is also essential that payers make full use of the functionality of interactive digital channels such as chat and SMS, which allow them to have real-time conversations and support sessions with members. For healthcare payers who use chatbots, natural language processing (NLP) capabilities are essential to accurately grasp medical terms and avoid friction.

Finally, automated interactions should be handled transparently by (and forwarded to) human staff as needed. There are simply limits to the types of questions and problems that can easily be addressed by bots. For interactions that require escalation or human intervention, the smart routing feature can ease member frustration and allow live agents to provide better support.

3. Get better grades

While member acquisition and retention will remain tangible measures of success, payers are increasingly using member satisfaction as a viable performance measure – just in time for the changes being made by the Centers for Medicare and Medicaid. Services (CMS) that will give more weight to customer experience metrics in determining the CMS Star rating for Medicare Advantage (MA) payers plans.

“We estimate that customer experience metrics will drop from around 32% of total weight for 2020 ratings to around 57% of weight for 2023 ratings,” McKinsey writes. “A great customer experience will be even more crucial in the future. “

Achieving and maintaining a high star rating is imperative for the success of AM plans, which McKinsey calls “the fastest growing industry for many health plans.” An interaction management platform may be the key to the ability of health plans to maximize MA performance payouts.

Members’ attitudes and preferences about how they engage with their health plans force payers to scale or run the risk of losing business. The right technology can drive payers’ engagement with members and ensure a smooth customer journey.

Greg miller is the vice president of industrial strategy, healthcare and life sciences for Talkdesk.

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