Three hot takes: Health plans and member service in 2017

2017 is emerging as a year of change for the health plan industry. From embracing virtual assistant technology to leveraging proactive engagement, Vance outlines three top trends for payers and how they will lead to better member engagement and outcomes.
Automation and self-service will be key health plan trends to watch in 2017.

I’ve always wanted to do a “hot take.” I’m a pretty big sports fan, and hot take alerts from ESPN analysts on everything from NFL draft reactions to college basketball power rankings pop up on my phone throughout the day.

So now, as we find ourselves approaching mid-year, I’d like to share my read on what I’m seeing in the health plan vertical from a self-service and automation perspective. I’m on calls every week with payers across the country, big and small, and as a result, I’ve seen common threads develop. So, with that, here’s my brief hot take (I’ve always wanted to say that) on the top three trends I’m seeing and what health plans are doing to address them.

  1. Tackling chronic condition management with virtual assistants, live chat and AI: I’ve thought for several years that we would begin to see more plans try to increase efficiency by gathering biometric data and other basic information from members through self-service methods like virtual – or intelligent — assistants. When it comes to care managers, health coaches, and disease management nurses, their time is too valuable to be gathering information about glucose level or weight. An omni-channel vendor should be able to enable an intervention by a nurse by escalating from the virtual assistant to live chat, as needed. I’ve finally seen this prediction break through in the past year, as multiple plans have taken tangible steps toward this capability and are looking to industry vendors to help them. Plans are investing in cognitive technology and analytics as they hope to derive insight from their data. And, as an aside, with data from CMS showing that accountable care organizations are continuing to grow at a 17% clip from 2015 to 2016, I would expect providers to follow suit in the next couple of years. (By the way, Nuance is well-positioned to support these efforts as we received the highest combined rating amongst intelligent assistant vendors in the newly-published report by Opus Research.)
  1. Leveraging “proactive engagement” to boost Medicare Star ratings: Medicare Advantage enrollment is projected to nearly double by 2025 to 30 million or 40% of the Medicare population. Medicare Advantage is an increasingly important part of payers’ business, and Star ratings then become even more critical. According to McKinsey & Company, Star ratings strongly correlate with enrollment growth and delivering preventive care is among the factors most strongly correlated with overall performance changes. That leaves me surprised at how few plans are using text messages, automated voice calls and emails to cost-effectively boost compliance with diabetic eye and foot exams, mammograms, cancer screenings and more. It’s a relatively mature technology, and for those payers eyeing a program like this, their vendor should be able to dispatch and manage reminder messages through multiple channels on one platform.
  1. Engaging shoppers and switchers with virtual assistants: Forty-three per cent of returning federal exchange enrollees changed plans in 2016, as opposed to 29% in 2015; 70% of those renewing coverage actively shopped for plans, compared with 53% in 2015. Individual members are becoming increasingly fickle and most are hitting plans’ websites to help them decide with which plan they’ll be enrolling. A payer’s site is its “front door,” so their website needs to be informative and easy to navigate. One top five plan deployed our virtual assistant using both English and Spanish versions on their desktop and mobile websites. The plan has seen strong results, achieving 77% 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. This has been another strong area of health plan inquiry in the market, so expect more of this approach as we enter another enrollment period later this year.

This is shaping up to be an exciting year in the area of automation. Would I rather be doing “hot takes” on football and baseball for ESPN?  Sure – but reaching the point where we’re consistently enabling members to interact with plans in the manner they want to, and boosting health outcomes along the way may be as exciting as a walk-off home run.

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Vance Clipson

About Vance Clipson

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