Health plans have a new best friend, and her name is Nina

Best friends have a special bond – standing up for and supporting one another to help achieve their goals. The health insurance industry is at a critical transition point, and needs a best friend of its own to increase member retention and re-enrollment in health plan marketplaces. The market is becoming more competitive as plan members are comparing customer experiences against the service they receive in all industry segments – airlines, banks, utilities, and more. In order to compete, plans need to provide a personalized, convenient way for customers to interact. Could a virtual assistant be the helpful best friend that health plans need?
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The health insurance industry is at a critical transition point, and needs a little help from a friend to increase member retention and re-enrollment.

How long have you known your best friend? Since grade school, college, or maybe you just met recently? No matter the length of your friendship, best friends have a special bond and share a unique relationship dynamic. Maybe you know each other so well you finish each other’s sentences. Maybe you can communicate with a glance. But most likely, your best friend would stand up for you when things got tough, supporting you by knocking down hurdles and helping to clear the path so you could reach your goals.

Well, it looks like one of the five largest health plans in the country has made a new friend – OK, an online virtual assistant – that is fulfilling a similar role during a time of transition in the health insurance industry.

Member retention and re-enrollment has surfaced as one of the top issues payers are trying to address as we find ourselves in the new exchange/marketplace era. Individual members, or those in employer groups that have selected a plan through an exchange – public or private – are not as likely to re-enroll in plans as traditional employer group members were in the past.

In fact, retention of state-based exchange members from 2014 to 2015 ranged between 67 and 90 percent. California and Kentucky were on the upper end of the spectrum, and even though Colorado used automatic renewals, they came in at only 67 percent retention. That’s lower than what we would want and should be a top priority for plans.

Health plans have had to put themselves in members’ shoes to understand that as consumers, members are used to being treated differently and have developed certain sets of expectations. Consumers have digital relationships with a variety of companies – likely a bank or two, a gas company, a couple of airlines, a number of retail stores, etc. – and members now expect their experiences with a health plan to work in similar ways as all other relationships. It’s simply no longer competitive to be better than your industry peers – you must deliver a consumer experience that lives up to the expectations created by these other industries.

That’s where a virtual assistant comes in.

Virtual assistants can provide human-like interactions across mobile and web. An advanced virtual assistant can easily understand who you are, what you say or type, and what you mean. They can engage consumers in a conversational, natural way to orchestrate a successful customer service outcome and a seamless cross-channel experience that creates loyal customers. Companies like Coca-Cola, BMW and Fidelity Investments are using Nuance’s virtual assistant, Nina, for cultivating their customer relationships. And savings from inbound call deflection doesn’t hurt either.

A virtual assistant can help in a variety of use cases and create a number of benefits for the consumer and a health plan. Whether “shoppers” are on a plan website looking for information about pregnancy coverage, a member is using a mobile app to request a replacement ID card, or a member logs into a plan portal to check the status of a claim, consumers want their questions answered as quickly and easily as possible.

The plan that deployed our virtual assistant at the end of July is using both English and Spanish versions on their desktop and mobile websites. The plan has seen strong results already, deflecting 35 percent of inbound calls and 74 percent first contact resolution in its most recent scorecard.

The health plan is experiencing a classic win-win situation; shoppers and members are getting their questions answered through an improved, seamless experience without needing to call in to speak with a live agent, and the plan sees reduction in costs. We expect to see even greater improvement and increased benefits once the virtual assistant is placed behind the member log-in and is able to help members find answers to more specific questions around claims, ID cards, benefits, etc.

That significant step should happen in the near future, and we may just get an invite for a “best friends only” slumber party.

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Vance Clipson

About Vance Clipson

Vance Clipson, senior principal, industry solutions for Nuance Communications, focuses on vertical-specific marketing and strategy with an emphasis on healthcare. Clipson brings 25 years of experience translating industry needs and data into market strategy and programs for Milliman, PacifiCare Health Systems and the American Cancer Society.