Temkin Group recently released their 2016 Temkin Experience Ratings, which grades companies across different industries on the basis of customer experience. It may not come as a surprise to my colleagues in the healthcare industry that health plans were rated lowest of all 20 industries evaluated. (No health plans were even ranked among the top 50 companies, though Tricare and Kaiser can claim the top two spots within the payer vertical.)

This doom and gloom comes as consumers have raised their expectations around consumer experience, based on the online self-service standards now set by retailers, delivery services, banks, and credit card companies. In addition, more than 16 million new consumers have enrolled in health insurance through Affordable Care Act-related programs (like the exchanges), and these members are often novices when it comes to health benefits, needing more guidance than a commercial member and more interaction with the plan, by default. Combine this with the growing emphasis on member engagement and chronic disease management, and health plans have their work cut out for them.

But all is not lost! I thought Kelly Rakowski’s recent article in Managed Healthcare Executive did a nice job of laying out three areas in which health plans can improve the member experience and potentially move up in the Temkin Ratings (perhaps because they’re topics I’ve steadily beat the drum about over the past couple of years):

1. Application and enrollment – As Rakowski states, “(payers need to) provide personalized, two-way communication to educate consumers about healthcare plan options that meet their individualized cost and care needs, and guide them through the application and enrollment process.” Plans need to ensure their websites are informative and easy to navigate throughout the “shopping” experience. Some plans are leveraging tools like web virtual assistants and chat for this, and many are employing proactive engagement channels like text, email and automated voice to inform applicants of status changes and actions required.

2. Operations and claims management – As it stands, members have a difficult time getting consistent claims information across various “channels”: whether on the phone, in the IVR, or through the member portal. And with the rise in individual members and high-deductible plans, this component is more important than ever. Rakowski is right that “providing clear information and appropriate levels of service and support to answer customers’ questions…is paramount to an excellent consumer experience.” Plans need to employ the same omni-channel approach that banks do, ensuring that data is shared across systems (whether mobile, web, IVR, etc.) and that members have easy access to help through virtual assistants and other intelligent self-service capabilities.

3. Care management and member support – Rakowski accurately points out that “(payers) should create vehicles to engage early with members, utilizing technology as well as clinically trained customer care agents…” More members are new to their respective plans these days and those with chronic or other complex care needs must be identified and interacted with early. I’m surprised at how many top plans are just now discussing the use of text messages and automated voice calls to improve enrollment in programs, boost adherence around scheduled nurse and health coach calls, or drive compliance with quality measure–related services. Some progressive plans are using self-service methods like virtual health coaches to provide guidance and education around chronic diseases. And, this is one area where member interaction is frequent enough to warrant voice biometrics (using your voice as your password) as a tool for increased security and enhanced member experience.

There’s a lot at stake here. Exchange members are increasingly fickle and bring a different set of expectations for service than what health plans are used to, and this results in lower retention rates and higher shopping rates than health plans are used to in their commercial business.

As a JD Power report recently put it, “health plans need to take a more customer-centric approach and keep their members engaged through regular communications about programs and services available through their plan. When members perceive their plan as a trusted health partner, there is a positive impact on loyalty and advocacy.”

Here’s hoping the next year brings an elevated member experience, and a spirited climb up the basement stairs into the daylight!