Health Plans: Achieving the Competitive Edge by Learning from Each Other

For many health plans, the Affordable Care Act has forced the industry into revamp mode. The market is more competitive and unforgiving than it has ever been. People have more options when it comes to their health plans and they aren’t afraid to change. Members are now true ‘customers’, and most health plans know they have to take a different approach when it comes to their customer service strategies.

One of my favorite events to attend each year is the Blue National Summit. It’s a consolidation of peers and organizations with the same goals and objectives, working together to find the best solution for their members. There is no mention of competition or weariness around sharing their secrets. They all have the same mission – providing superior member experiences to retain existing business and grow new business, and there’s so much to be learned.

As I spent time with some of the Blue Cross Blue Shield organizations, I saw that many of their initiatives were communications and process oriented. Although most of them didn’t know where to start with the transformation of this experience, they quickly started relating back what they’ve seen with competing companies and other industries. The discussions turned to what their expectations would be as customers, and how they could meet their own demands. Many of the solutions discussed turned out to be things they already had in place, but needed to be revaluated.

  1. Business Process Automation – At the root of every interaction lies a process. Blending network inquiries, coverage changes and billing processes with communications allows for more efficient request handling. When a member calls in, take what you know about them (previous interactions, life events, etc.) to better gauge what they may be calling about. This creates a more personalized experience, while also increasing first call resolution and cutting back handle times.
  2. Collaboration – One of the main member complaints is the lack of communication between the payer and provider. Through EMR integrations and collaboration tools, provider/payer/patient transparency (in a secure fashion) evolves, and the overall member experience is improved naturally. Everyone has the information they need, when they need it.
  3. Self-Service – Many industries are starting to figure out the art of making self-service a preferred communications channel. Through member portals, intelligent IVRs and more seamless integration with back-end systems, self-service can help free up resources for common inquiries like claim status, document requests and coverage details, not to mention giving your business a 24-7 support feel without the resources.
  4. Cloud-based Technologies – Cloud communication solutions not only free up IT resources, but allow for scalability and growth. With the ACA, the health plan business has only increased, meaning prospect and member inquiries are increasing as well. Cloud communications allow plans to implement various solutions and resources easily when and where they are needed, recognizing that the demand of the business is changing constantly.

Is your organization starting to take a look at any of these solutions? How are you leveraging what other industries are doing as a starting point for your own customer service initiatives?