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Bringing CX to Health Insurance

Austin Ridgeway, Director of Sales Support and Business Development, HGS Healthcare

Mandeep Singh Kwatra, VP, HGS Solutions and Capabilities and CX Strategy Services Leader

In an increasingly connected and digitized landscape, health insurance organizations need connected, automated systems in order to optimize member acquisition and retention.

The legacy systems and department silos that shaped many health insurance organizations over decades are no longer optimized to drive success in today’s consumer-centric environment. The millions of new potential customers and increased competition in the market are compelling health insurance organizations to implement efficiencies and innovations that tap into connected customers.

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Too much member data is isolated in disparate systems or isolated by service type, department, and even entire market segments. As a result, it is difficult for the insurer—although in possession of a wealth of health-related data—to see an individual’s full purchase history, interactions and preferences in a single view.

Through the aggregation of member data, insurers gain the ability to continuously evaluate the customer lifecycle and the likelihood that members are in need of and will purchase and enroll in additional services. Without the technology to integrate member health data and preferences, insurers may fail to meet consumers’ rising expectations for a seamless and satisfying experience, leaving members frustrated and difficult to retain.

What Are the Drivers of Digital CX?

The drivers of this shift to digital CX fall into three broad categories—regulatory, technological, and generational.

  • Regulatory—The shift to value-based care and the passage of the Affordable Care Act (ACA) changed the fundamental dynamic of healthcare purchasing and delivery, respectively. The establishment of marketplaces, which allow individuals and small businesses to compare standardized coverage options, placed unprecedented power in the hands of healthcare consumers.

Technological—Our digital “insta-age” of smartphones, texting, social media and increased online engagement makes it easy for consumers to compare prices and plans, receive recommendations, and learn from their experiences. The empowerment that comes with access to this technology has fundamentally changed how customers get serviced today.

  • Generational—The growth and influence of the millennial generation is promising to upend the traditional ways we shop for and purchase health insurance. Today’s consumer—Millennials more than others—don’t want to have to climb a company’s phone tree for more information. They want access to real-time information online. A customer who has no problem texting with a vendor for an hour, may give up in frustration if they’re put on hold for 10 minutes.

Health plans are starting to wake up to this trend—some are even tapping the customer experience as a business metric. An intensely loyal member is an advocate who creates the perception of reliability and credibility in the marketplace.

A critical aspect of engaging members is to deliver a unified, seamless experience across the channel or device of the members’ choice be it via smartphone, laptop, landline, email, or online chat. However the member chooses to engage with the insurer, the plan must be ready to meet (and even anticipate) the member’s needs.

The Front-End of Consumer Engagement

One of the key disconnects on the front-end of customer service is understanding how to use multiple channels of engagement—and how consumers feel they should seamlessly flow together. For example, simply having a social media handle does not necessarily mean that you are servicing customers. Most insurance companies tend to use it for marketing, but only through integration and strategy does it become a viable service.

Health insurers have traditionally had relatively few touchpoints with members and so fewer opportunities to build loyalty. Therefore, it is critical to create opportunities to engage with members and build affinity whenever a touchpoint occurs—from enrollment, onboarding and health plan education to appointment reminders and change-of-life events.

Simply put, businesses should be prepared to meet their needs with self-service channels that help them get the right answer, fast. They need multiple channels with cross-channel integration, including self-service. Millennials expect service to be consistent, quick, proactive and guided by preferences, present on multiple channels and focused on optimized CX.

Focusing on the Back-End

Boiled down to its essence, the back-end of this transformation seeks to answer one question: How do I tell a unified, integrated engagement story?

Your organization has multiple channels of service—chat, social, and phone—but  how integrated are they? Can a customer start a conversation on the phone, them move into text or chat and pick up exactly where they left off? Can they visit your website, read some content, and then start a chat anytime?

Digital transformation has changed the paradigm by which goods and services are delivered to consumers in myriad sectors. Yet, healthcare has been stymied by aging systems and a lack of health data integration, in part necessitated by patient privacy regulations. As a result, payers—although in possession of a wealth of health-related data—lack insight into members’ full history and preferences.

Therefore, it is critical to create opportunities to engage with members and build affinity whenever a touchpoint occurs—from enrollment, onboarding and health plan education to appointment reminders and change-of-life events. Tailoring member specific service based on these unique circumstances and preferences is dependent on a robust data analytics platform within the insurer organization.

The Backbone of Digital CX

With the aggregation of member data, insurers gain the ability to evaluate and re-evaluate the customer lifecycle and the likelihood that members are in need of and will subscribe to additional services. Without the technology to integrate member health data and preferences, insurers will fail to meet consumers’ rising expectations for a seamless and satisfying experience, leaving members frustrated and difficult to retain.

The backbone of digital CX is a mix of self-help automation and live agents. For example, suppose a member visits your organization’s website to learn more about health plans or obtaining insurance. What if, instead of static information, it was presented in a question-and-answer format—backed by an intelligent knowledge base on the back-end—that hones in on that member’s specific needs? If the next step of action is channeling the member to a live agent, like a nurse concierge service on a video chat platform, it’s done seamlessly so as to avoid having the member begin their query from scratch. This is an example of back-end knowledge and tying it in to a front end tool.

The Operations Perspective

Regardless of the engagement methods used, the goal is to amass integrated member data to identify individually-appropriate interventions to best manage their health. To achieve this shift, insurers will require a cloud-based platform integrated into business process outsourcing (BPO) services. The total solution must go beyond the member-facing channels to also provide integration with enterprise customer relationship management (CRM) platforms.

From an operations perspective, such a platform would facilitate streamlined health plan set up, claims administration and member lifecycle management. All member participation information could be captured in a CRM that integrates with multiple back-end systems to inform and accelerate the sales process. Back-office agents could leverage the data captured within the platform to provide suggestions on how to balance member costs per month with the best possible outcome; adjudicate or pay claims quickly and automatically; conduct root-cause analysis before a new plan is implemented; proactively look for claims-related savings opportunities and initiate recovery; and make the entire end-to-end process more efficient and accurate.

Health insurance plans that embrace digital transformation of this magnitude stand to achieve substantial efficiency improvements in acquiring new members and providing services over the course of the customer lifecycle.

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