Member Experience Issues in Health Insurance | Uniphore

Member Experience Issues in Health Insurance | Uniphore

4 min read

Member satisfaction with health insurers is at its lowest level in five years, according to the American Customer Satisfaction Index (ACSI). Satisfaction with health insurance contact centers remains low as well, unchanged from the previous year. Compared to the other industries for which ACSI provides benchmarks, only hospitals and communication service providers scored worse than health insurance companies for customer satisfaction.   

Given that the latest findings span a 12-month period from October 2019 through September 2020, the pandemic alone wasn’t responsible for the dissatisfaction across the industry. It’s more likely that the challenges brought on by the pandemic amplified and exacerbated existing issues and trends. 

Experience and Satisfaction Impact the Bottom Line

While rankings help tell the story of member satisfaction with their health plans, the greater impact for insurers is the affect of satisfaction on financial performance of the company. Member experience and satisfaction impact the bottom line in multiple ways: 

  • Satisfied members are less likely to churn, improving retention and reducing acquisition costs  
  • Higher satisfaction scores translate into higher Centers for Medicare & Medicaid Services (CMS) Star ratings for quality, which in turn, mean eligibility for bonuses and rebates
  • Higher ratings attract new members  

According to McKinsey, insurers offering Medicare Advantage plans have been leaving money on the table (an estimated $2.9 billion in 2020) in Stars-related payments because of their quality ratings. Plans awarded 4 or more Stars earn a 5% bonus on CMS payment benchmarks, as well as higher rebates to use toward supplemental benefits for members. McKinsey estimates that Medicare Advantage plans in aggregate received approximately $12.2 billion in Stars-related payments in 2020.

Soon, there will be even more financial incentive to improve member experience for Medicare Advantage plans. A May 2020 rule from CMS indicates that customer experience metrics will begin to carry more weight in determining plans’ Star ratings. Instead of customer experience being around 32% of the total weight for 2020 ratings, the rule will see it increase to around 57% of the weight for 2023.

Treating the Experience Problem

It’s imperative for health insurers to take a hard look at member experience and create a strategy to significantly improve the experience, satisfaction, and retention. Fortunately, recent advances in conversational artificial intelligence (AI) are proving highly effective in helping insurers overcome contact center challenges to deliver a positive, frictionless experience for members and agents alike, while reducing costs. 

Here are three use cases that spotlight how healthcare insurers can optimize and personalize the member experience using conversational AI, automation, and other advanced technologies.     

Use Case #1: Apply conversational AI to member self-service

Improving the member experience starts by understanding and optimizing every conversation before, during, and after an agent/member interaction. Often the conversation starts in a self-service channel. Using conversational AI, health insurers can increase self-service and automation rates and deflect transactional interactions from contact center agents — all while delivering an optimized member experience.      

Use Case #2: Reduce friction in the member journey

Conversational AI optimizes every conversation by enabling agents to be more productive and empathetic while personalizing the experience for members. With a conversational AI and automation platform that can understand the customer’s real intent, emotions, and implied needs, contact centers can deliver a more conversational experience that eliminates friction in the member journey and improves member satisfaction.

Use Case #3: Automate after-call work

What happens after the call ends can be just as important to your contact center’s business outcomes as what happens during the conversation. The time spent in after-call work (ACW) — including categorizing and summarizing the call, updating systems, and taking follow-up actions on promises made during the interaction — impacts average handle time, call waiting times, member satisfaction, costs, agent productivity, and agent satisfaction. Insurers can use conversational AI and automation to automatically handle ACW to achieve a remarkable return on investment.  

Following a Real-World Example

A large health insurance company operates multiple contact centers with 1,000+ agents that handle more than one million calls annually. After-call work was taking too much valuable agent time and prevented the agent from participating fully in the conversation with the member. The more time spent on after-call work, the longer the average handle time and the longer the wait times for other members.    

After adopting Uniphore U-Self Serve and U-Assist for intelligent self-service and in-call agent assistance and automation of agent after-call work, the health insurer reduced average handle time by 20% and after-call work time by 80%. 

Now members can self-serve for simpler questions and when they need to talk to an agent, they don’t have to wait as long. Conversational AI optimizes the experience for both the member and agent during the call and helps the agent be more productive after the call. 

Learn more about how conversational AI and automation can resolve member experience problems in the ebook “Four Ways Conversational AI Improves Member Experience and Reduces Costs.”

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