Scratching the surface: Healthcare needs to build on its intelligent omni-channel achievements

During the first 11 days of the 2018 open enrollment period, Healthcare.gov’s volume was up 74%. While that surge has leveled off since, volume remains strong – so how can insurance exchanges, whether federal, state or private better optimize such inbound activity? Health plans experience similar spikes around this time of year – how can they resolve “shopper” or renewing member inquiries while maintaining a strong customer experience? Payers and exchanges should consider conversational artificial intelligence and outbound customer engagement to strategically manage these periods of activity.
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It’s been an interesting ACA healthcare open enrollment, with curtailed marketing budgets, a shortened enrollment period and spiking Healthcare.gov volumes early on. Add in the political debate surrounding the program and there’s plenty to discuss.

While the complex questions around how we insure people efficiently and affordably are important to discuss this time of year, the administrative aspect of our healthcare system is one also worth some attention. How can we make it more streamlined and get the right information into people’s hands at the right time? It’s here there is potential for comprehensive omni-channel customer engagement systems, similar to those used in industries like banking and telecommunications, to alleviate the huge burden for health plans and government call centers and websites this time of year.

During the first 11 days of the 2018 open enrollment period, Healthcare.gov’s volume (as represented by plan selections received) was 74% higher than during the first 11 days of the 2017 open enrollment period. While that surge has leveled off since, volume remains strong – so how can insurance exchanges, whether federal, state or private better optimize such inbound activity? Health plans experience similar spikes during open enrollment season – how can they resolve “shopper” or renewing member inquiries while maintaining a strong customer experience?

We’re seeing some illustrative examples in the market – leveraging virtual assistants (also referred to as intelligent assistants or chatbots) with conversational artificial intelligence and outbound customer engagement – that payers and exchanges at all levels should be considering:

  • A large ACA exchange is using automated outbound voice messages to alert those consumers that need to take action. This approach is a great example of proactive customer service and can actually drive more volume to the call center and website, letting members know their plan is changing or being eliminated, reminding them that they need to re-enroll, or notifying them if they haven’t completed their application yet.
  • One of the largest health plans in the country is using Nuance’s virtual assistant to answer administrative, benefit and network questions, achieving 81% first contact resolution and 55% live call deflection. They continue to build on useful capabilities, including Spanish and mobile versions, an ability to escalate to live chat and an integration with a member’s account information that enables claim-specific questions to be answered.
  • The largest private insurance exchange in the US uses Nuance’s outbound automated voice and text status updates to proactively deflect calls into their contact center. They’ve been thrilled with the results, as they’ve been able to reduce “per message” cost by 94% (with text messages) and achieved a 95% customer engagement rate with the application.

All plans and exchanges should be availing themselves of these kinds of omni-channel self-service solutions – but they’re just a starting point. Whether it’s being leveraged for a health risk questionnaire, a monthly check in with a chronic patient or a post-discharge assessment, these intelligent systems are being used by other industries with great success, but we’re just scratching the surface in healthcare.

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Health plans and exchanges should be using omni-channel self-service solutions to reduce inbound volume and increase member satisfaction.

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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.