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The member engagement journey: From Highlands to health plans

Health plans have added 12.2 million new exchange members this past open enrollment season and individuals make up 45% of those with health insurance. These members bring their expectations for customer service to their new health plans. Are the exchanges prepared? Vance outlines the three stages of the modern customer journey and how health plans can improve customer retention.
Planning a trip to the Scottish highlands is like orchestrating health plan customer journeys – you need to focus on enrollment, management and retention.

I’m currently in the middle of planning a family trip to Scotland this summer, and servicing my nine-person entourage, consisting mostly of the Campbell clan, is already necessitating more interactions and communications than I can handle well. Just as a journey of this type is forcing me to reassess how I handle all these touchpoints, businesses’ development and examination of customer journeys are helping them to make decisions about how to improve customer acquisition, service and retention.

Health plans are no different, and with the 12.2 million new exchange members added this past open enrollment, individuals now make up fully 45% of those with health insurance. The experience of health plan members throughout their journey now has higher stakes than ever, as these individual customers can typically switch plans at the next open enrollment, and perhaps sooner if they’re picking a particular Medicare Advantage plan.

I’ve found it useful to develop a view of the health plan member journey wearing my “omni-channel glasses” so that I – and the clients I work with — can better understand the touch points that are most impactful for members, and the best opportunities for self-service and automation. When done intelligently, this automation can lower operational costs (e.g., reduce the necessity of live agents) while enhancing customer satisfaction – a key to retention.

Just as I’m viewing my Scottish sojourn in three broad stages (Edinburgh, the Highlands and the Islands), I’ve grouped the health plan member journey into three stages, with specific touch points, interactions and opportunities within each:

  1. Acquisition and enrollment – The most prominent touch points within this stage include shoppers’ online plan evaluation, as they review benefits and network, and their early inquiries regarding application status, ID cards and understanding of the plan – especially for those new to coverage. Plans need to ensure their websites are informative and easy to navigate throughout the “shopping” experience – whether we’re talking about kilts or copays. Some plans are leveraging tools like web-based virtual assistants and live chat for this, and a top ten plan is seeing 45% inbound call deflection and 78% first contact resolution through use of such an “intelligent assistant.” Insurers can also use automated outreach in the form of texting, email or voice to apprise applicants of their status, including a missing information notification or a welcome call with a quick overview of next steps. The eHealth private insurance exchange and a major healthcare regulatory agency have used Nuance’s platform to send more than 40 million similar messages to prospective members this past open enrollment period.
  2. Clinical and care management – 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, automated voice calls and virtual assistants to more cost-effectively perform health risk assessments, and then improve enrollment in health management programs such as diabetes or CHF. Automated outreach – often called proactive engagement is increasingly being used to boost adherence around scheduled nurse and health coach calls, or to drive compliance with selected HEDIS/Star measures. I’ve seen a significant increase in health plan interest around the use of our virtual assistants and live chat to take pressure off nurses and health coaches, allowing them to focus on the most valuable member interactions. Virtual (or intelligent) assistants can conduct assessments, provide guidance and education around chronic diseases, and escalate to live chat with a nurse, if necessary. 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. I can’t make any promises about how it would deal with the Scottish brogue we’ll encounter in Inverness.
  3. Service and retention – As it stands, members have a difficult time getting consistent claims information across various “channels”: whether on their mobile, in the IVR, or through a member portal. And with the rise in individual members and high-deductible plans, this component is more important than ever. Plans should employ the same omni-channel approach that banks do, ensuring that data is shared across these systems through a unified data layer. Members should also have easy access to help through virtual assistants and other intelligent self-service capabilities.

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 J.D. 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.”

Today’s consumer doesn’t want to be tethered to an explanation of benefits or a phone tree as they work with their health plan. They want what William Wallace (fictitiously) declared: “Freedom!”

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The Re-Enrollment Model: 3 Keys to Retaining Exchange Members

Learn about the expectations of the new health consumer, and the tools and strategies that can improve experience and re-enrollment.

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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.