The U.S. health insurance industry is at a crossroads. Customer demand, government legislation, and even internal voices are all signaling for the industry to make changes. As far as the customer experience goes, most healthcare companies' reputations are on proverbial life support. They typically rank the lowest among both the American Customer Service Index (ACSI) and Forrester's Customer Experience Index, and the general consumer perception is that of a cold, uncaring industry.
For health insurers looking to improve the customer experience, many obstacles stand in their way. Elizabeth Boehm, principal analyst at Forrester Research, says the complexity of the industry combined with regulatory roadblocks and inefficiencies all contribute to the stagnation of the industry. "Most health plans aspire to be more consumer-friendly and to build customer experience competencies within their companies," Boehm says. "But they still face substantial hurdles in the form of regulatory constraints, [like] state-specific or CMS-mandated communication rules, employer restrictions, and sometimes unrealistic consumer expectations."
She adds that many of the problems within the health insurance industry are deep-seated and difficult to change easily. "They range from the disconnect between the buyer (the employer) and the actual user (the consumer), to the lack of traditional focus on the consumer as customer, to one-size-fits-all product development, and even to the incredible complexity of the delivery of medical care. Customer experience disciplines are not going to solve these overnight."
Boehm says that, in general, health insurance face three main obstacles when it comes to even the simplest of customer experience improvements:
1. Organizational buy-in. "Often the people who understand that customer experience is broken sit in a customer service or even eBusiness department within the health plan," she says. "These frontline groups see customer experience issues first. But they often have little or no influence over product development or legal departments whose decisions have an enormous impact on customer experience."
2. Regulatory constraints. "Rules that govern what health plans are required to say to consumers are often created with good intent, but implemented with a clearer understanding of legal requirements than of consumer needs. And they vary from state to state. In short, regulations often require plans to use legal jargon and provide specific communications, regardless of how helpful they are to consumers.
3. Employers. "As long as employers negotiate and purchase benefits contracts, consumers will always be one step removed from making those critical decisions," Boehm says. "And with communication, employers mean well and often have very valid (to them) reasons why they constrain communications to their employees. But those constraints add complexity to health plans' communication processes, and sometimes inhibit plans from delivering best-practice solutions."
So what's a health insurance company to do? Boehm's advice is to focus on measurement and analytics as powerful customer experience tools to start the change process and show progress. "Understanding what the real problems are and how they affect loyalty, medical utilization, and administrative cost is absolutely critical to helping the industry both improve its reputation and curb the rising costs of health insurance," she says. "Getting the data is a start, but then companies will also need to use it to inform decision-making in all of their business processes, from product development to sales and service."
The industry is changing, and some companies have already begun to move the needle toward improved customer service and satisfaction. "The industry is certainly making strides," Boehm says. "I speak with health plans every day that are trying to improve customer experiences and serve the needs of consumers."