Elevating CX in the Healthcare Payer Space: Trends and Insights

There’s no time to waste for elevating customer experience in the healthcare payer space. Avaya’s latest research shows that only one-third of members believe their health plan primarily acts in their best interest, and only 25% view their health payer as a trusted partner in their wellness. About 70% of members also say that customer service problems stress them out to a considerable extent.

The industry now has very complicated customer experience demands as it serves members, employers, and providers, creating many different customer journeys that all need to be designed and delivered well.

Here’s what healthcare payers should consider…

The Importance of Omnichannel Customer Experience has Grown

Like other markets Avaya has studied, most consumers in the healthcare payer space want improved support from a range of channels (a.k.a. omnichannel). Channels that have risen in importance in the industry include email, video conferencing/video chat, mobile apps, web chat, text/SMS, and FAQs on an organization’s website.

Unlike other industries, however, there remains a sizeable number of members who desire traditional face-to-face, phone, and paper service (29%). This can be attributed to a greater volume of interactions that are complicated in nature (e.g., understanding coverage and costs, confusion over deductibles, name misspellings on insurance cards). It’s crucial that healthcare payers offer a seamless, engaging experience across both digital and traditional channels.

Personalizing the Experience for Members and Member Groups has Become a Priority

Growing expectations and the rise of Accountable Care Organizations (ACOs) have accelerated the need for personalization in the healthcare payer space, and research suggests this personalization pays off. One study conducted in 2020 found that payers who personalize the member experience could see five times higher retention rates. Payers that prioritize personalization also report up to a 20% increase in effectiveness of member engagement and 20% lower costs.

Successful organizations will strengthen their reach and market share by using data to deliver personalized and frictionless experiences across all channels. The use of AI solutions like virtual agents also enable personalization at scale with capabilities like intelligent customer routing, sentiment analysis, and conversational AI. Consider, for example, a member who starts a chat session with a bot. The person could say in their own words why they are reaching out, with the bot able to conduct natural, human-like interaction that improves as the solution grows in intelligence. McKinsey estimates that this kind of personalization at scale has the potential to create up to $3 trillion in new value.

Health Advice is Increasingly Being Offered by Payers

Providing concierge and health advice to members is vital and now acts as a point of differentiation in the healthcare payer industry. The explosion of video use among customers (from 30% in 2019 to 90% in 2021) has opened the floodgates for payers to offer virtual education on medicine adherence, wellness best practices, vaccinations, and patient self-responsibility. This investment in health advice and education is well worth it, with research proving a correlation between better-informed patients and lower cost of care.

Proactivity in Care is Vital to the Member Experience

Avaya’s research indicates that 50% of people are more worried about their health than before the pandemic. As insurers play a more active role in customers’ care journeys, proactive care becomes crucial for differentiating and enhancing service. One customer we surveyed, for example, commented that their insurer calls to remind them of prescriptions that are ready for renewal and that this makes for a more positive and memorable experience.

Payers and providers can also work together to provide proactive, coordinated care while reducing healthcare costs. In 2014, for example, Aetna and Banner Health Network collaborated on an accountable care model that helped improve cancer screening rates, reduce radiology services by 9%, and reduce avoidable admissions by 9%.

Healthcare payers can achieve these customer experience objectives by adopting the agility, speed, scalability, and innovation more commonly found in the technology sector:  

• Dynamic and easy-to-integrate technology (a.k.a. composable architectures) 
• Seamless EHR and CRM integration to drive personalized member engagement
• Systems linked through simple low-code, no-code application programming interfaces (APIs)
• Scalability across multiple accounts and customers
• Increased investment in cloud-based communications to take advantage of services such as mass notifications, virtual agents, and customer journey analytics

Learn more about the key elements healthcare payers should consider to digitally evolve with Avaya’s Life and Work Beyond 2020 research. View the full report about Trends Shaping the Healthcare Payer Industry.