Making Good on Quality Healthcare Promises

With the healthcare reform mostly in place, health payers should focus on the changes they need to make in order to deliver on their promises of providing quality healthcare.
Customer Experience

Healthcare has come under major scrutiny in the past months as the United States geared up for the implementation of the Affordable Care Act (ACA). While aptly nicknamed ObamaCare, the ACA has had its fair share of glitches. The focus now, however, has shifted from the effectiveness of the online interface and registration process to health payers and their ability to deliver on promises of quality healthcare.

Yet, most consumers have low expectations for health insurers, explains Bruce Temkin, managing partner at Temkin Group. But despite these low expectations, citizens desire a number of things from their health payers. "They want help in making informed decisions when they select a policy, select a covered doctor, and when they go through difficult medical decisions," he says. "They don't want to run into surprises about what's covered and how much it costs."

Unfortunately, many times patients are left confounded, especially at a time when they are already facing a stressful situation. While the health sector is a complicated one, patients and members want the same experience they have come to expect from best-in-class companies, and according to experts it greatly revolves around a personalized experience. As Paul D'Alessandro, principal and customer experience practice leader at PwC, notes, in today's new health economy, "patients" are first and foremost "consumers." These patients, he says, have "both the freedom and responsibility" that come with making more decisions and spending their own money. "As 'patients' behave more like 'consumers,' healthcare companies need to deliver a higher level of personalized service, satisfaction, and overall experience or risk losing business to the competition," D'Alessandro says.

However, health payers have traditionally found it difficult to offer the same individually tailored and targeted experience that customers have come to expect and appreciate. Dawn Aston, TeleTech's vice president of sales, healthcare services, explains that despite having enrolled members, insurers haven't really personalized the experience. "Their systems aren't integrated and designed to focus on being customer centric," she notes. James Smith, senior vice president at The Camden Group, agrees, noting that since health insurance was historically purchased through employers, the focus has been on meeting the needs of these clients as opposed to the direct needs of employees or their families. "This is changing given the movement of the market to public and private exchanges and more and more membership being moved to individual contracts and high deductible plans," he says.

One of the main deficiencies lies with the need to integrate data from the different databases. Although health insurers have ample data on their individual customers, Aston explains that there are still major challenges to leverage this information to identify high-risk members or engage with those who haven't fully taken advantage of the system. For example, a member with high blood pressure can, and should be, alerted about the risks this condition poses, including dangers of cardiac arrest or stroke. "Health insurers can easily identify those who are very sick," Aston says.

Becoming a trusted advisor

Temkin agrees. He notes that one priority for health insurers should be to become "much easier" to work with. This, he says, will only be possible when they better understand their members' entire journey. "It's not good enough to look at each interaction as a separate activity," he says. "Health plans need to better understand members' emotional highs and lows throughout their lives and they are interacting with their health plans."

Further, with all the changes in healthcare, many citizens are confused and unsure how they are going to be impacted. Dan O'Neill, associate vice president of business development, at Practice Fusion, notes that health plans need to take an active role in guiding patient decisions. Dan Brown, vice president of marketing operations at Verint, notes that many members want to know what the ACA means to them, and are calling their insurance provider for answers. Blue Cross Blue Shield Michigan grabbed the bull by the horns and created a Website to help both its own members and other U.S. residents navigate the complicated changes. The site was meant as a resource to simplify the changes, a knowledge tool that broke down a very complicated issue into bite-size information that was easy to digest with the added bonus of providing prospective members with the necessary information to avoid long phone calls.

Yet, there will always be members who want to talk with another person, especially when it revolves around a subject as important as healthcare. Brownhighlights the importance that agents are well-trained in the nuances of the guidelines and requirements, allowing insurers to deliver on members' expectations. "It's imperative to make changes to the frontline," he stresses. Apart from training agents in engagement practices, it also requires listening to customers and using these insights to make changes in the customer engagement process, including fine-tuning the routing process based on customers' different needs.

Even the more informed members tend to find the health landscape a tough one to navigate. This, experts believe, should be an opportunity for health payers to reach out to members and provide information that's most pertinent to their individual needs. One example, Aston notes, is providing details about a wellness program. "There's a large part of the population who might not be familiar with their benefits," she says.

Further, the legal framework today allows, and even encourages, payers to reduce fees for members who manage their health risks. This requires the development of targeted communications that help members make the most of programs that address their individual needs. Skip Snow, Forrester's senior analyst for healthcare, says some of the larger for-profit insurers are doing well with regards to the institution of different wellness programs that can help their members improve their health and potentially prevent future health challenges. In large part, this success is due to large payers' access to technology that is allowing them to have more targeted interactions.

Beyond the transaction

A major change that health payers should be embarking on in order to deliver the experience today's member expect is a move away from transaction-based services. As D'Alessandro explains, the healthcare industry has to date adopted "situational" customer-oriented improvements on its online portals, for example the ability to look up physicians in a network, check claims, or make appointments. "Insurers need to push beyond transactions to join together with doctors to jointly provide more holistic care for individuals," he says. One example is making an effort to replace insurance and healthcare jargon with simple and clear language.

AsBrown notes, the ACA is propelling a change in business direction for insurers from an employer-driven focus to a customer-oriented one. "In a customer-dominated world, other industries have led consumers to believe they can have what they want, when they want it, and how they want it," he explains. "Insurers are now adjusting to that culture by putting more focus on individuals."

Yet, this massive transition won't happen overnight since it requires a complete change in culture. Skip Snow, Forrester's senior analyst for healthcare, notes that while there's a swing towards customer-centricity, health insurers have traditionally found it problematic to develop relationships with customers. "It's a slow pivot and no health insurance has mastered this relationship change," he says.

Further, changes also need to take place in the way insurers treat their members.Brown explains that the formerly uninsured have different profiles than insurers are used to. "They have different cultural, education, and language profiles than prior members," he says. This means that health insurers will have to adapt to serve these customers, for example taking into consideration language barriers and hiring agents with different language abilities. "Insurers have to make an effort to understand these new member profiles better and train frontline employees on ways of providing them with quality service," he says.

The healthcare reform has given members more control over their health insurance choices than ever before. But this also means that just like in other aspects of their lives, customers have increased freedom to move from one insurer to another when they feel they're not getting the experience they expect. "Regardless of whether the healthcare industry wants to accept it or not, expectations are being set by non-related industries," D'Alessandro stresses. It is up to health payers to make the necessary changes to deliver an outstanding member experience as part of their retention strategy. "Insurers need to engage with them quickly to create an experience that's positive," Aston says.