Health Insurance Member Services Trends and Best Practices

In recent years, there have been significant advancements in how health insurance companies deliver services to their members. Innovations like digital platforms and personalized guidance have transformed how individuals interact with their health insurance plans. 

Here’s a look at five recent innovations in health insurance member services with real-world examples:

1. Digital Transformation: Embracing Technology

The health insurance industry’s digital transformation is one of the most significant member services trends. Health insurance companies now leverage technology to streamline processes, enhance communication, and improve the overall member experience. Online member portals, premium billing payment portals, and mobile apps allow members to access their policy information, view claims, pay premiums, find doctors, and schedule appointments. These platforms provide convenience while empowering members to take control of their healthcare journey.

Devoted Health’s use of the Apple Watch is an example of an insurer embracing technology to provide a better member experience. The startup Medicare Advantage provider began the first health plan to offer the watch as a fitness benefit to its members in 2019, offering a $ 150-a-year wellness benefit for classes, programs, and wearable devices like the Apple watch. The wellness benefit is part of the plan’s push to encourage healthy behaviors by leveraging technology.

2. Personalized Guidance: Tailoring Support

Recognizing that every individual has unique healthcare needs, health insurance companies are adopting a more personalized approach to member services. Using data analytics and artificial intelligence, insurers analyze member data to provide tailored recommendations and support. Members receive personalized health-related content, reminders for preventive screenings, and guidance on managing chronic conditions. This proactive approach helps members stay healthy and make informed decisions about their care.

Kaiser Permanente is well-known for its integrated care model, helping the organization consistently achieve high member satisfaction scores. Part of that integrated care model is a connected data system that captures and shares data with clinicians, care teams, and members. Kaiser members can access that data through the organization’s member portal, while clinicians have digital access to individual member history. That enables a more personalized experience and better health outcomes.

 3. Telehealth Services: Expanding Access

Telehealth has gained significant traction recently, and health insurance companies are incorporating these services into their member offerings. The service allows individuals to connect with healthcare professionals through video consultations, phone calls, or secure messaging. This innovation improves access to care for those in rural or underserved areas. Members can receive medical advice, prescriptions, and even mental health support from the comfort of their homes.

Alignment Health, a startup Medicare Advantage plan, was among the first to offer virtual-first health plans. The first entry for a member in a virtual-first health plan is with a virtual provider – usually a primary care provider. Alignment uses 24/7 access to its ACCESS On-Demand Concierge platform to answer health-related questions, schedule appointments and arrange transportation. It also provides telehealth providers with a 360-degree view of the member. 

4. Wellness Programs: Fostering Healthy Lifestyles

Wellness programs have become an integral part of health insurance member services. These programs promote healthy behaviors and incentivize members to engage in activities that improve their health. Health insurance companies offer various initiatives, like fitness challenges, rewards, and discounts. By encouraging healthy habits, insurers help members prevent diseases while reducing healthcare costs in the long run.

Cigna invested in a dedicated app – Cigna Wellbeing – to promote healthier lifestyles. Members can complete health assessments, manage chronic diseases, get personalized health advice, connect with a personal wellness coach, and access other health information, like healthy recipes.

5. Enhanced Customer Support: Ensuring Member Satisfaction

Providing excellent customer support is crucial for health insurance companies to build trust and maintain member satisfaction. Insurers are investing in robust customer service systems, including dedicated call centers, live chat support, and self-service options. These improvements ensure that members can easily access the assistance they need, whether they are resolving billing issues, understanding their benefits, or navigating complex healthcare systems. A focus on prompt and effective communication helps members feel supported and valued.

But that commitment also requires people. Employees and member services culture play a role in a health plan’s service acumen. Take Blue Cross and Blue Shield of Kansas City, who have won numerous customer service awards, including having the highest customer satisfaction in the Heartland according to JD Power. Why? The organization has invested in its employees. Seven Blue KC supervisors and eight leads achieved World Class Certification from Service Quality Management (SQM). SQM named an additional 64 customer advocates World Class Certified Customer Advocates. Additionally, Gratia Carver, a Vice President and Chief Experience Officer, was recently awarded Customer Experience Leader of the Year by Awards International. A highly trained and rewarded member service team leads to high member satisfaction.

The health insurance industry is witnessing remarkable innovations in member services. Digital transformation advancements aim to deliver personalized guidance while telehealth services enhance the member experience. Wellness programs and improved customer support further contribute to ensuring member satisfaction. Health insurance companies must stay ahead of the curve and embrace these health insurance member services trends and best practices to meet the ever-changing needs of their members.

Certifi’s health insurance premium billing and payment solutions help healthcare payers improve member satisfaction while reducing administrative costs.

Member Engagement - A Health Insurer's Guide

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