Health insurers seek to turn the script on customer experience

For decades, American consumers have experienced interactions with their health insurance providers that feel confusing, bureaucratic and indifferent. Care their doctor has recommended is inexplicably denied, obviously necessary procedures require maddening weeks of paperwork and hoop-hopping, bills (and bill-like documents) arrive in the mailbox listing startling costs. Sadly, frustrating interactions like this have been the norm in healthcare, but those days may be over for good. Payers are now acting aggressively to fix their broken consumer experience, shore up their beleaguered brands, and invest in getting their technology and business processes in order.

Big tech companies look to their own relationship with healthcare consumers

The reasons for this shift have a lot to do with changes in government regulations, the emergence of “new breed” payers like Oscar Health, and increasingly aggressive big tech moves in healthcare. The latter is perhaps the most important driver, as companies like Apple, Amazon, Google and Microsoft are finally gaining traction in the healthcare sector. If there’s one thing big tech knows how to do, it’s its customer experience. Insurers now understand that if they don’t start acting less like the DMV and more like Amazon, they will find themselves stuck in the back seat for the next evolution of healthcare.

Big tech is a significant and more imminent threat to the healthcare establishment than ever before. Changing healthcare laws and regulations have fundamentally changed the way insurers manage risk and cost. The Affordable Care Act (ACA) made it illegal to deny coverage or bill the sick far more than the healthy; MACRA has made value-based care the reimbursement model of choice. More recently, CMS’s price transparency and interoperability rules make it much easier for healthcare consumers to shop and much harder for healthcare organizations to keep consumers in the dark.

All of this has created an environment where big tech is in a good position to leverage its vast consumer relationships to drive advances in healthcare, and it’s moving fast. Apple’s latest iOS health features are seen as a milestone on their journey to becoming the consumer’s choice for engaging the health system. Amazon has announced plans to expand its Amazon Care service to major metropolitan areas nationwide. The US healthcare establishment has downplayed the great technological threat for years, but today it recognizes that the threat is more imminent than ever and must be taken very seriously.

Payers Invest to Counter Big Tech Threat

As payers seek to fend off Silicon Valley invaders, they can leverage the powerful advantages they enjoy as long-time incumbents: deep knowledge of healthcare, existing customer relationships, and detailed data on consumers and suppliers. On the other side of the balance sheet, they face a consumer reputation crisis due to bureaucratic cultures, outdated technology, data scattered across siled business units, poor customer service record and the perception that they are obstacles rather than facilitators of, caring.

Payers are getting aggressive and smart about changing things. They recognize that brand loyalty is a sea battle that will take a lot of time and energy to change course. Health plans are considering both upfront and backend changes to radically transform how they interact with members. Ultimately, they want to eliminate internal bureaucratic mindsets and project a proactive desire to delight consumers. But to do that, they know they need to step outside of their traditional framework, leverage expertise from other industries, and dramatically improve their learning and communication with their customers.

A New Era in Healthcare Consumer Experience

Today, health plans take the member experience very seriously and invest in a wide range of new capabilities to change the way they interact with members and build a new reputation as modern, focused organizations. digital and consumer-centric. These capabilities include omnichannel communications, telehealth services, digital admission, care facilitation apps and more. All are designed to facilitate better communications and take a more active role, leveraging clinical and claims data to intelligently interact with members and guide them to the care they need. These initiatives will not only increase member loyalty and satisfaction, but will also reduce long-term medical costs.

Focus on communication

A centerpiece for payers looking to become more consumer-centric is transforming the way they communicate with their members. This includes going beyond phone and fax and leveraging conversational voice/chat interaction, inbound and outbound digital engagement apps, and communication hubs to drive engagement, compliance, and engagement. completion of care. Sophisticated digital communication modalities are new to most health plans. As a result, they are increasingly outsourcing to partners that deliver the kind of cutting-edge customer communications experience they need, including smart apps, bots, and call centers that generate personalized interactions at the stolen based on member data.

Another important aspect of consumer sentiment is examining generational and demographic differences in communication preferences. Young people and people in certain parts of the country tend to prefer digital or asynchronous communications – secure text over live chat. Other groups, including many Medicare members, have been shown to respond very well to digital communications with structured options (eg, “Press 1 to confirm your appointment”). Building brand preference in a diverse community requires multi-channel communication capabilities that can connect using print, text, phone, web portal and apps and be ready to embrace all new forms of communication favorites that will emerge next.

Leverage the incumbent advantage

Knowing a lot about your customer is a significant advantage. Amazon is famous for amassing a wealth of consumer data, using it to intelligently guide the shopping experience and make it incredibly easy to buy. Health plans also know a ton of their customers, having built detailed individual profiles that include clinical, financial, and demographic data. They also tend to know a lot about the communities their members belong to and the major health issues they face. This is a powerful resource, but it’s also a double-edged sword, as members of the Health Regime wait their insurers to know them well. When their insurer fails to get the data and communication right, they can pay a very high price for consumer loyalty.

A new era of payers at the center of the health-consumer relationship is upon us. Driven by the threat of big tech, payers are finally starting to catch up with other industries and make innovative use of technology to deliver the kind of experience consumers expect. Early movers will be positioned to make the most of this trend and will need to partner with experts for the technology, best practices, and process improvements needed for long-term success.

Photo: marsmeena29, Getty Images

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