With the United States per capita healthcare spending roughly two times the average of other wealthy countries, you’d expect America to boast better health outcomes. However, of countries such as Switzerland, Japan, Ireland and the United Kingdom, the U.S. has the lowest life expectancy at birth, the worst infant mortality rate and the highest rate of unmanaged diabetes.
With the average annual per-person healthcare spending in the U.S. at $15,074 and the rise of healthcare consumerism, Americans expect more from their healthcare providers – and payers. Many want their interactions to be convenient and digital, and a poor customer experience doesn’t cut it.
Healthcare Consumers: Dissatisfied with Payer Experiences
More than 70 percent of consumers point to experience as an important factor in their purchasing decisions — only behind price and product quality. According to Forrester Research, though, customer experience (CX) quality ratings for U.S. health insurers have dropped to a five-year-low with about one-third of the industry earning “poor” ratings.
A study by KFF found similar CX complications:
- Almost 60 percent of insured adults say they have experienced a problem using their health insurance in the past 12 months.
- Two-thirds of adults in fair or poor health experienced problems with their insurance.
- Nearly half of insured adults who had insurance problems were unable to satisfactorily resolve them, with some reporting serious consequences.
- Approximately half of insured adults give their insurance a negative rating when it comes to the availability of mental health providers.
Another study, this one conducted by J.D. Power, indicated that healthcare payers aren’t meeting consumer preferences for a digital experience. The survey notes that almost one-third of digital properties from health insurance companies fail on basic functions, and 32 percent of payer websites and apps don’t meet the foundational level of functionality and intuitive organization of information. It’s no surprise, then, that 42 percent of insured adults say they have experienced a problem using their health insurance website and/or app in the past 12 months.
Boosting Payer Performance Through Member Engagement Strategies
Effective healthcare member engagement not only builds brand loyalty but also leads to better adherence to treatment plans, higher satisfaction and reduced medical costs. It encourages members to take an active role in their health and promotes a sense of ownership and responsibility, both of which translate to better health outcomes and lower healthcare spending.
Comprehensive engagement strategies that consider the entire healthcare experience are essential for health plans. These strategies should include personalized experiences, effective digital communication and the use of digital health tools to empower members. The result is a more satisfied and loyal member base, which leads to increased member retention.
Despite the clear benefits, healthcare payers face several challenges in implementing effective engagement strategies. One is synthesizing structured and unstructured data to create impactful insights. Health insurers often struggle with processing this complex information, which is essential for targeted and personalized member interactions.
Regulatory, privacy and compliance issues further complicate the transition to data-driven decision-making. Ensuring compliance with government regulations and securing protected health information (PHI) is a daunting task. And, the absence of predictive health insights can hinder identifying at-risk members, limiting the effectiveness of interventions.
Other payer barriers to member engagement consist of high operational costs, inefficient communication and non-compelling content, all of which can lead to disengagement among health insurance members. Overcoming these obstacles requires accessing up-to-date data, developing operational efficiencies and improving member satisfaction, all of which can be done through technology tools powered by artificial intelligence (AI).
Leveraging Advanced Analytics for Better Member Insights
Advanced analytics are crucial for effective member engagement, offering actionable insight to promote evidence-based decisions. Utilizing diverse data sources like claims information and social determinants of health (SDOH) helps payers better understand members’ needs and behaviors. This enhanced understanding should be used to guide health insurers’ engagement strategies.
Employing predictive analytics procured through AI enables payers to forecast potential quality issues and intervene before they escalate. That data-driven decision-making provides valuable insights into member behavior and preferences, leading to improved engagement strategies and a competitive market advantage. Also, tracking member behavior and creating actionable personas allows insurers to tailor engagement efforts to meet specific needs, resulting in more meaningful interactions.
Personalized Messaging and Multi-Channel Communication
Personalized messaging is an essential component of effective member engagement. Consumers expect personalized communications from companies, and failing to meet these expectations can lead to frustration and disengagement. Sending personalized content based on interaction history creates more meaningful and tailored interactions.
Equally important for enhanced member engagement is a omni-channel communication strategy. Companies using such a strategy have the potential to retain a much higher percentage of their customers compared to those with a weak set of tactics, providing members options based on their preferences. As part of their omni-channel communication strategy, payers should utilize various platforms, including conversational AI, mobile apps, social media and email to reach members and provide consistent and compelling content.
Empowering Patients: Digital Tools for Healthcare Payers
The emergence of digital tools has substantially enhanced the member experience in healthcare. Mobile applications and patient portals provide easier access to health records and clinical information, empowering members to take control of their health. Telehealth services offer more accessible healthcare options, enabling consultations regardless of geographical barriers.
Aligning business and technology goals is a necessary precursor to implementing successful engagement strategies. Once that alignment is achieved, leveraging advanced technology enables insurers to offer personalized interactions and efficient experiences.
Leveraging Conversational AI to Transform Member Engagement
AI has the potential to transform member engagement by automating routine tasks and streamlining administrative processes. Handling member identification, verification and common inquiries, digital tools equipped with this technology improve efficiency and free up time for payer staff to address more complex needs. The result is increased productivity, improved staff satisfaction and a higher member retention rate.
Take prior authorization, for example. The average for verifying prior authorization is ten days, but analysis by McKinsey & Company estimates that using AI for the process could decrease manual effort by 50 to 75 percent.
AI is a cost-effective option for payers. A study by Accenture postulated that insurers could save up to $7 billion over 18 months using AI-
driven technologies by streamlining administrative processes. The study also projects that healthcare payers could save $15 million per 100 full-time employees (FTEs) simply by automating routine business tasks.
Consumers are on board, too, with the use of AI in health insurance. According to market research firm The Harris Poll:
- Two-thirds of insured Americans say they would trust a payer’s AI copilot to accurately inform them about a health plan’s benefits.
- Approximately 65 percent of Americans believe AI can correctly personalize digital healthcare with the goals and needs of the member.
- Nearly three-quarters of insured Americans want to receive health and well-being recommendations from their health plan after a medical visit regarding a specific medical concern.
- An overwhelming majority of respondents say they want health apps to allow for easy scheduling of follow-up appointments and to give access to around-the-clock care.
Conversational AI solutions equip payers with a cost-effective solution to aid in mitigating the repercussions of ongoing staffing shortages, decreasing the number of hospital readmissions, boosting payment collections and more. They offer interactive and personalized explanations of member health benefits in real-time and enable consumers to quickly locate available healthcare providers, both of which empower members to make informed decisions. Also, by reducing the need for manual phone calls and offering 24/7 availability with multilingual support, such tools meet consumer expectations for convenience and quick service.
In claims disputes, conversational AI can be utilized by payers to expedite resolution times and reduce administrative costs. For population health management (PHM), the technology can be used to personalize outreach efforts to different patient populations. Whatever the use, conversational AI solutions offer the scalability to handle member inquiries, even during peak periods of operation.
Providertech for Payers
Providertech’s conversational AI solution is designed to understand patient communication and adapt accordingly. Meeting healthcare consumers’ expectations for a seamless experience, we ensure patient satisfaction in every interaction — happy patients every single call, every single time.
Listen to a sample recording of Providertech.ai, or contact us today to learn more!
