Scoring an “Ok” Satisfaction Rating Isn’t EnoughContact centers are the main touchpoints with members, greatly impacting overall member satisfaction. In fact, more than four out of ten members (43%) report that they prefer the call center as the primary channel for communicating about their health plan. More than half also say they want service representatives to have their information upfront when calling and 71% of members say shorter contact center hold times would improve their engagement with health plans.2. A Forrester poll of members of 17 of the largest health plans in the country found an industry average score of 70.2 on a 100-point scale for customer satisfaction, which Forrester categorizes as an “OK” rating. What’s the key to driving improved customer satisfaction? Out of six categories included by Forrester, customer service is the number one driver.3 Diving a little deeper into the data, drivers relating to how well customer service agents solve problems have the most impact on an insurer’s overall customer experience score. The authors of the report state that “sadly, brands failed to excel in this area. Nearly half of brands fell below the industry average in this category, pinpointing an anchor that’s weighing down the industry as a whole.”4
Understanding Customer Service Challenges for U.S. Payers
For payers, new challenges that arose during the pandemic — the pivot to work-from-home, acceleration of digital healthcare adoption, and worsening staffing shortages, to name a few — exacerbated many of the “pre-existing conditions” that already impacted the experience for both healthcare consumers and customer service agents.
Today healthcare organizations continue to struggle with:
Conversational AI and Automation Optimize Experiences and Reduce Costs
Optimizing the member experience starts by understanding and optimizing every conversation before, during, and after an agent/consumer interaction — from self-service to agent assistance to after-call follow-up and post-interaction analytics.
That’s where conversational AI is making a tremendous impact on helping payer contact centers address the challenges they face to drive improvements in member satisfaction, customer experience index scores, operational efficiency, and other strategic metrics.
Conversational AI is a set of advanced technologies that recognizes and comprehends human language and uses this understanding to optimize, automate, and analyze conversations in and across multiple channels. With a conversational automation platform powered by AI, payer contact centers can use machines to automate conversations and augment agents, including:
Automate common, repetitive inquiries with personalized self-service via an omnichannel intelligent virtual assistant (IVA), supporting voice, web, and mobile channels, to offload interactions while accelerating resolution. An IVA with conversational AI passes the context from an IVA to the contact center to create a frictionless experience for patients or members who need further assistance.
Conversational AI optimizes every conversation by enabling agents to be more productive and empathetic while personalizing the experience for members. By using conversational AI to understand the consumer’s real intent and sentiment, contact centers can help agents deliver a more conversational experience while resolving issues faster.
Automating ACW improves accuracy and productivity as well as enhances the consumer’s and the agent’s experience.
Automate post-interaction analytics on 100% of contact center conversations to gain deep insight into trends and opportunities for improving member satisfaction and operational efficiency. Automated analysis detects patterns across voice, email, text, or chat to identify trends such as the volume of calls that are related to claim denials, billing, or eligibility
Delivering Better Member Experiences With AI
One of the largest Medicaid managed care organizations serving more than five million members in 13 states and the District of Columbia needed to simplify and automate its contact center operations to deliver a better experience and drive better health outcomes for members.
The managed care organization adopted the Uniphore Conversational Automation platform for its real-time agent assistance and automation solutions. With Uniphore, the organization can now provide its agents with real-time guidance including next best actions, best practices, and compliance as well as automation for ACW and call dispositioning. With the right context and member information at their fingertips, agents make members aware of gaps in care and recommend actions that improve health outcomes.
The changes affecting the U.S. healthcare market continue to pick up pace, even as the impact of the pandemic begins to lessen. Consumers are raising their expectations more every day. They seek out payers that deliver the type of convenient, fast, and empathetic experiences they’ve come to expect from other sectors.
Conversational AI and automation address many of today’s ailments in the patient/member journey while improving efficiency and reducing operational costs at the same time. Choosing the right conversational automation platform that addresses the entire member conversation from self-service to post-interaction analytics can help your organization deliver a positive, frictionless experience for your members.
1 – “Administrative Simplification: How to Save a Quarter-Trillion Dollars in US Healthcare” McKinsey & Company, October 2021
2 – “Digital Member Experience Services May Boost Plan Satisfaction” Victoria Bailey, HealthPayerIntelligence, September 2021
3 – “Forrester: These Are the Payers With the Best Customer Experience”, Paige Minemyer, Fierce Healthcare, September 2021
4 – Ibid