How to Improve the Member Experience: Tips and Technology for Health Insurers

Simply put, a poor health insurance member experience can hurt an insurance company financially. Take Medicare Advantage enrollment, for example. CMS assigns Medicare Advantage plans star ratings based in part on member outcomes and member satisfaction. The star ratings are a way for Medicare Advantage members to compare plans and, as a result, a higher percentage of enrollees select highly rated plans. Highly rated plans – which most likely have better member experiences – generate more revenue. So if you improve the member experience, it’s likely you’ll improve your financial performance.

With that in mind, here are four tips — with potential technology solutions — that can help improve the member experience and your financial performance:

Don’t Buy a Wave Pool Company.

WeWork’s co-founder, Adam Neumann, once notoriously invested nearly $15 million into wave pool company, Wavegarden. Why would a company that essentially delivers coworking spaces invest in wave pools? Realistically, it was because Neumann was an avid surfer who wanted to incorporate surfing in or near properties WeWork leased.

What does that have to do with a health insurer’s member experience? Simple: Don’t invest energy in edge cases. Study your member experience through the eyes of your members to determine common member journeys that have less-than-desirable outcomes first. Later, once you’ve mastered the core member interactions, you can focus on unique features or invest in cutting-edge technologies. But until you’ve perfected your most frequently followed member paths, you’re minimizing impact.

How do you do that? In any number of ways. We previously wrote about Health Insurance Member Journey Mapping, which is a good start. By better understanding your members and their journeys, you can improve those experiences.

Technology Considerations

From a technology perspective, many health insurers are leveraging AI chatbots, web portals, phones, and chat as touchpoints. As a result, their member support teams lack cross-channel visibility into a member’s interactions, the visibility that can provide context that helps member support teams better serve members.

Many insurers have solved that problem by integrating a web-based contact center solution that unites all that data to deliver a better view of member interactions. Example providers in Talkdesk, Five9, and UJET.

Move beyond “Hi <first_name>!”

We’ve all been there. We receive an email that aims to personalize our experience. But the only way they’ve attempted to do that was by including our first name in the salutation. Even worse, the sender didn’t have our first name, so it only includes a boilerplate like “first_name.” That’s not personalizing an experience.

So move beyond inserting names into communications. Create personalized messages that meet the member where they are. The key to developing a trusted relationship is not wasting time with generic communications. How do you do that? By rethinking your technology systems and by putting the member at the core of your technology. Then, build tools and content around that member’s activity.

For example, if your member is pregnant there are several content journeys they can experience, from how to select an obstetrician to pregnancy nutritional needs, from proactively delivering highly-rated, low-cost birthing center information to reminders to schedule one, two, four, and six-month baby checkups. By providing helpful resources that help the member navigate their local healthcare system, you’ll be more likely to engage the member, improve their care and in a value-based environment, minimize spending.

Another recent example is COVID-19 vaccination scheduling. For many, navigating the complex vaccine recommendations given their age, vaccination status, and health status was difficult. Finding a location with vaccines early in the vaccination roll-out could have been difficult. For insurers with the right data, helping members navigate the vaccination process would have not only helped improve member engagement but also potentially reduced the number of insureds seeking COVID-19 treatment, saving money in the process.

Technology Considerations

From a technology perspective, this member-centric approach is available through vendors like Accolade and Castlight Health. Additionally, several new venture-backed insurers have built their own internal systems to be more member-centric. One of them, Oscar, has also attempted to sell their technology to other insurers, with Cigna being among the first purchasers.

Skate to Where the Puck Is Going, Not Where It Is.

Vision is an underrated attribute of successful athletes. As Wayne Gretsky once said, you need to skate to where the puck is going, not where it is. By the time you get to where it is, it’ll be elsewhere. You’re chasing, not anticipating.

Likewise, a good health insurance member experience anticipates member needs rather than reacting to members. There are many ways to anticipate a member’s needs, and most of them require data-based solutions.

For example, some insurers have begun to offer wearables in an attempt to motivate members to achieve healthy lifestyle goals or to monitor patients with chronic conditions. Insurers can then use AI to identify when an intervention may be required and suggest a telehealth visit or alert the member’s primary care physician.

Instead of reacting when a patient seeks care, a health insurer is more intimately connected to a member’s healthcare needs and outcomes. That proactive outreach can help improve member satisfaction.

Technology Considerations

Humana leveraged Salesforce’s Health Cloud to deliver a coordinated care platform.  HealthEdge’s HealthRules Care Manager is another example of a coordinated care platform as is EXL’s CareRadius.

Think Apple, Not Dollar General

For many retail businesses, moving from a retail experience to an online experience can be difficult. Compare the experience of buying an Apple product online or in a retail environment to buying something at a dollar store like Dollar General in-store or online. The Apple experience is vastly superior and leads to a better brand and loyal, repeat customers.

Though most insurers don’t have retail establishments, they do have several different channels members leverage for information. Web portals, chat, phone, email, etc. are all channels insurers leverage to engage members. If the experience is significantly different on one of those channels, it can lead to a poor brand experience and potentially disengaged members.

For example, I’ve seen some health insurers that have a great member portal but use an unbranded, third-party health insurance premium billing portal that is difficult to navigate and lacks basic payment options. For a process a member may have to use monthly, it must be simple, yet highly functional.

Technology Considerations

From a technology perspective, some multi-experience development solutions enable companies to build and customize mobile apps, websites, and web apps while supporting third-party chatbots as well as voice apps for Amazon’s Alexa or the Google Assistant. The software is designed to streamline development across multiple channels while delivering a consistent experience. Some sample vendors include OutSystems, which Humana has leveraged to cut development costs and timelines, Salesforce, which UnitedHealthcare uses to deliver more member-centric care, and SAP’s QualtricsXM.

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

Member Engagement - A Health Insurer's Guide

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