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The truth – and consequences – of maximizing member experience and re-enrollment

For health plans, sustaining and increasing a customer base isn’t a game. Plans face a ticking clock as the end of the open enrollment period approaches. In order to win in this competitive market, health plans need to understand the massive impact that customer service has on retaining enrollees. Consumers have more options and are no longer shy about making a plan switch, so payers increasingly need to stay on top of what their members want and need.

The U.S. Department of Health and Human Services (HHS) expects 10 million people to enroll through government-run insurance exchanges by the end of the current period, up from 9.1 million last year. This will shine a light on the issues created by the increasing amount of interactions plans have with shoppers and enrollees. In addition to the complexities of transactional issues such as incoming calls, outbound communications and other administrative functions, we’re also seeing a shift in terms of service expectations.

Consumer behavior in the health plan market is changing, and there are both challenges and opportunities associated with this change. At the risk of dating myself through a 1970’s cultural reference, is your plan ready for the annual game of “Truth or Consequences?”

To help uncover the “truth,” we dedicated a Webinar to the topic of maximizing health plan re-enrollment, where we discussed three key consumer experience strategies and recommended self-service tools to support them.

Retention, switching and shopping rates

Exchange members are more fickle and bring a different set of expectations for service than what health plans are used to. JD Power and the Robert Wood Johnson Foundation found state exchange retention ranged from 67 to 90 percent last year and 29 percent of federal exchange members switched plans. But some exchanges are seeing an even more extreme number of enrollees jump ship for other carriers. On the Rhode Island exchange, 69 percent of enrollees switched plans.

So what is causing this massive shift and how are members shopping for new plans? Re-enrollees primarily use online research while shopping, particularly through health plan websites (58 percent), followed by general online search (51 percent) and online consumer reviews (29 percent). Health plans need to ensure their websites are informative and easy to navigate, as modern shoppers are more likely than their predecessors to leave online reviews for either a poor or impressive experience

Expectations of the new health consumer

Consumers have many digital relationships with a variety of companies – likely a bank or two, utilities, a couple of airlines, and a number of retail stores. A health plan is no different. Members expect to have similar, modern experiences with a payer – your plan is no longer different than any other consumer relationship they have. 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. The 2015 Temkin Ratings, which evaluates the customer experience of 293 companies across 20 industries ranked health plans eighteenth – just ahead of cable and internet providers.

One of the key areas requiring innovation is self-service. Automated technologies are critical to engaging the exchange population. 88 percent of Millennials and 86 percent of Baby Boomers have used self-service options and a growing majority of all consumers believe self-service is an improvement over traditional, live customer service.

Questions, consequences and opportunities

This means unless you’re actively working to improve the self-service experience, you’re automatically driving members to call center agents, which consumers increasingly don’t want. This not only drives up contact center costs, but also ripples into member retention.

A recent Wakefield Research survey demonstrated that 87 percent of consumers say that a company’s customer service has a significant impact on their decision to do business with them. The study also showed 45 percent of consumers stopped conducting business with a company after a frustrating consumer experience and 31 percent wrote a negative online review. These are some severe consequences for ineffective customer service. On the flip side, 55 percent of consumers would recommend a company to friends and family after a great customer service experience and 47 percent will conduct more business with the company in the future. The new requirements for high quality customer service are clear, so how do we get there?

Three key consumer experience strategies

We’ve identified three key characteristics of self-service solutions that customers love – and more importantly – use; self-service solutions need to be intuitive, conversational and anticipatory. Our Webinar includes specific descriptions, best practices and technology recommendations to support these, so please carve out 45 minutes to watch, or feel free to contact me for the webinar deck. In the meantime, to steal from Bob Barker, here’s hoping all your consequences are happy ones!

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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.