3 Keys to Health Insurance Customer Experience

In the decade following passage of the Affordable Care Act, the health insurance industry made dramatic but often gradual progress toward a new era of consumerization — slowly rolling out new digital tools aimed at helping Americans shop for, understand and use their health insurance.

Then came 2020. The onset of the COVID-19 pandemic dramatically, almost instantly accelerated the shift to digital commerce, and digital health. Last year the share of consumer interactions happening on digital channels jumped to 65% — from 41% in 2019 and just 25% in 2018.

Businesses across every industry responded by implementing and launching technologies in months that would normally have taken them years. The number of organizations reporting 80% or more of their transactions as digital tripled.

The result is a shift in consumer expectations that can't be reversed — and that won't bypass health insurance. As consumers who now use digital tools for two-thirds of their shopping and purchasing, plan members will no longer be satisfied with manual processes, tedious phone calls or analog tools for managing their health care.

This subject is of obvious interest to the plans. It's also of interest to benefits brokers or consultant. A health plan's "CX" (customer experience) strategy is an important part of what the broker is selling.

Plans that hope to attract and retain those members — and their employers — can no longer view the shift to digital member experience as a long-term process. Just as during the depths of the COVID crisis, transformations that would have taken years if begun in 2019 must now be completed in months.

Fortunately, the tools they need to make those transformations already exist. There's no reason for a health plan to build its own digital experience — it would take too long, cost too much and quite likely fall short of members' expectations by the time it launched. By partnering with the right software platform, plans can quickly implement and launch digital solutions that will fuel better outcomes, exceed members' expectations — and win their loyalty.

As they seek the right solutions, plan leaders can improve their chances for success by focusing on three strategic factors: exclusivity, agility and efficiency. Here's a closer look at each.

1. Exclusivity

Health plans don't just need CX. They need CX for health insurance.

In the last decade many health plans have implemented off-the-shelf CRM software for use in various aspects of operations — some of which are key CX components. But while these solutions can deliver quick upgrades to sales and marketing processes, care coordination or customer services, they can't deliver CX transformation on their own.

In health care there are simply too many complexities, too many peculiarities and too much at stake to implement generic solutions. Health plans need CX software that can handle their unique workflows, challenges and requirements. Next-best actions, interoperability, compliance and database integration are all critical to delivering the contemporary CX that today's consumers expect. Building those functions rapidly requires deep industry expertise — the kind that only comes from working exclusively in the health insurance vertical.

2. Agility

A health plan needs a CX system that can be implemented in just a few months, not one that takes years to create.

So, if exclusivity and health-insurance expertise are so vital, why shouldn't health plans build the technology themselves? Because when they do, it rarely ends well. Self-builds rarely stay within budget or meet key deadlines, they strain internal resources — but still require immense investments in contractors and consultants — and often fail to keep up with constantly changing technology advances.

Instead of pursuing the rip-and-replace approach, health plans should seek agile solutions that can be built on top of their existing technology infrastructures. That's the only way to launch a new CX strategy and start engaging customers in a matter of months.

An agile platform should also come with goal packaging — cutting-edge software that uses the plan's historical knowledge to quickly identify next-best actions for members based on individual strength and risk profiles. The result will be an immediate return on investment in the form of improved outcomes. Member satisfaction will follow, driving improved star ratings and CAHPS scores.

3. Efficiency

A customer's total experience matters more than individual point solutions.

For most health plans, attempting to transform their CX can feel like trying to boil the ocean. From their member portal to member communications to customer service, it can be difficult to know where to begin — and impossible to do it all at once.

Many plans try to pick a single experience and tackle everything related to it — for members, brokers and providers — before moving on to the next phase. A health plan might decide to focus on launching its mobile app this year and wait to move on to a service bot for digital customer service next year.

They no longer have that luxury. Members expect a contemporary digital experience at every point of interaction, and they expect it today.

Meeting those expectations calls for a holistic strategy that upgrades the member experience across the plan's platform. Plans should seek modular solutions that connect to their legacy systems through APIs and can be rapidly customized, extended and upgraded. This way they can launch the mobile app and service bot within a few months' time, rather than in consecutive years.

However they approach their digital transformations, it's critical for plan leadership to remember that CX is more than just a nifty interface for their existing members. It should be a platform that syncs sales processes, member services and provider functions. The proper architecture creates efficiencies, frees IT departments to focus on day-to-day upkeep and troubleshooting — rather than relentless implementations and upgrades — drives sales and builds member loyalty.

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Mark Nathan is the founder and chief executive officer at Zipari, a health insurance consumer experience technology company.