How payers can manage member interactions with a cloud-native digital platform – MedCity News

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By Greg Miller
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Healthcare organizations are innovating and adapting faster than ever before to remain competitive. Dramatically changing market needs and intensified consumer expectations resulting from the pandemic have forced healthcare providers and payers to evolve.
Two years ago, for example, virtual care and telehealth services were rarely offered by providers or covered by payers. Today, telehealth services are common and payer reimbursement routine because consumers demanded them in the early months of 2020, and providers and payers reacted.
Similarly, today’s healthcare consumers are no longer willing to tolerate poor customer support. They want self-service, rapid issue resolution, and multiple options for support channels – from both providers and payers. The consumer revolution that has transformed retail, finance, entertainment, and other industries also applies in healthcare.
Health plan members now judge payers based on every interaction and touchpoint throughout their journeys. These members expect to interact with health organizations through the channels of their choice – be it phone, text, email, or virtual assistant – wherever and whenever they choose. This trend toward increasing consumer choice and empowerment has been bubbling under the surface in recent years, with the pandemic merely accelerating the process.
More health insurers are paying attention. Nearly one in three (32%) commercial health plan members said in a J.D. Power survey that they connected with their health plans over the past year via web, mobile app or text message, the highest percentage ever.
“The past year has proven without a doubt that effective use of digital channels has the power to increase customer engagement, build trust and promote brand advocacy,” said James Beem, managing director, global healthcare intelligence at J.D. Power. However, Beem says, plans “still have a long way to go when it comes to delivering consistently strong levels of customer engagement across all segments of their member populations.”
Recent progress notwithstanding, health insurance remains one of the lowest-rated industries in terms of consumer satisfaction, according to J.D. Power. The good news for health plans is that both the demand for, and availability of, modern customer support platforms offer a great opportunity to boost member engagement and brand loyalty.
A platform for managing member interactions, powered by artificial intelligence (AI) and automation, enables payers to offer members a synchronized, personalized, and convenient experience – similar to what they get in more consumer-friendly industries such as online retail. This kind of communication and information hub provides payers with a strong competitive edge.
A differentiated – and superior – member experience can drive tremendous value for payers. Here are three ways health insurers can make that happen:
Providing members with a large variety of digital engagement tools is essential for payers to successfully compete in the era of consumer empowerment. But offering a collection of disparate point solutions isn’t enough. Mobile apps, online portals, messaging apps and call centers must be tightly integrated so that members can transition easily from one to another without having to repeat requests or provide the same information over and over.
A member, for example, may initiate a query in the morning on the payer’s website from a home computer and then try to follow up using a mobile app while out at lunch. The payer must ensure that the information provided to the website via home computer is captured and available through the member’s smartphone app. Otherwise, the frustrated member must start from scratch. For members who need regular or frequent contact with their health plans due to ongoing episodes of care or management of chronic conditions, constant roadblocks and cul-de-sacs could drive them to another health plan.
To orchestrate the member journey, many large payers are deploying a single platform to manage all interactions — voice or digital. These platforms serve as a command center for health plan member interactions by supporting omnichannel digital engagement. Such platforms can coordinate responses to member questions and requests through the channel preferred by the customer, including via live agent.
A streamlined, cloud-native platform that integrates with CRMs and enables cross-channel support can speed time to resolution, improve the member experience, and enhance brand value.
The healthcare industry has long lagged other sectors in adoption of technologies. Payer-member communications are an obvious example. Typically, these consist of 1) one-way outbound communication (mail or email) of information regarding payments or benefits changes, and 2) inbound requests from members to answer questions or raise concerns. Patient queries may come through phone calls, emails, texts, patient portals, or mobile apps.
In addition to unifying the member journey, platforms for managing all voice and digital interactions can transform the ability of payers to proactively engage members in dialogue by leveraging the same digital channels members use and prefer. It is important, though, that payers refrain from using these digital channels to bombard members with the equivalent of spam. Instead, payers must tailor content to each member. This can be done through event-based management software that can segment member populations based on highly specific data points such as age, health status, location, and channel preference.
Payers also must fully utilize the functionality of interactive digital channels such as chat and SMS, which enable them to have real-time conversations and support sessions with members. For payers that use chatbots, natural language processing (NLP) capabilities are necessary toward accurately capturing medical terms and avoiding friction.
Finally, automated interactions must be seamlessly supported by human agents if needed. Impressive as bot technology has become, its ability to effectively address questions and problems still has limits. For interactions that require escalation or human intervention, smart routing functionality can ease member frustration and empower live agents to provide better support.
Though member acquisition and retention will continue to be viewed as tangible measures of success, more payers are using member satisfaction in and of itself as a viable performance metric – just in time for the changes by the Centers for Medicare and Medicaid Services (CMS) that will give more weight to customer experience metrics in determining CMS Star ratings for payers’ Medicare Advantage (MA) plans.
The weight of these customer experience measures will increase for the 2023 ratings to an estimated 57% from 32% of the total weight for 2020’s ratings, consulting firm McKinsey predicts. Achieving and maintaining high Star Ratings is imperative to the success of MA plans, which McKinsey calls “the fastest-growing line of business for many health plans.” A platform for managing interactions can be the key to the ability of health plans to maximize MA performance payments.
Fast-changing member attitudes and preferences regarding how they engage with their health plans are forcing payers to evolve or run the risk of member attrition. A cloud-native technology platform that allows payers to drive engagement on members’ terms will help them retain and grow business.
Photo: shylendrahoode, Getty Images
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