The Rise of Healthcare Consumerism and its Impact on Payers

Healthcare payers have an immediate opportunity to create an effortless experience by anticipating members’ needs in the channels that they prefer.

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According to Deloitte’s 2015 Survey of US Health Care Consumers, consumers’ trust in the reliability of information sources is rising. According to the survey, 52 percent of respondents report searching online for health or care-related information, and one-quarter of consumers say they have looked at a scorecard or report card to compare the performance of doctors, hospitals, or health plans compared to 19 percent two years ago.

This points to a marked increase in self-directed engagement, and there’s no doubt that the rise of technology, apps and member-friendly portals have made it easier for these consumers to take healthcare matters into their own hands. Since adoption of the Affordable Care Act, the healthcare industry has been shifting towards a direct-to-consumer model, driven largely by the changing ways by which consumers interact with businesses. Consumers are now accustomed to the effortless experience they have with companies such as Amazon and Uber, who prioritize ease and efficiency at every touchpoint. As such, consumers increasingly expect to feel just as empowered when interacting with healthcare providers and payers.

Payers can no longer get by with providing members an outdated service or an inconsistent experience. Hundreds of millions of people, both uninsured and insured, have rising expectations that stem from the ease and efficiency of interaction they experience with brands in other facets of their lives. In other words, healthcare no longer gets a “pass,” and smart customer engagement is no longer an option—it’s a prerequisite for survival in an increasingly competitive landscape.

Healthcare payers have an immediate opportunity to create an effortless experience by anticipating members’ needs in the channels that they prefer. Many channels and devices (from websites to mobile apps to social media) are available to policyholders during interactions involving sales, enrollment, service delivery and care management. Payers can grow their membership and manage costs by orchestrating a customer experience that centers on self-service options and offers a seamless, effortless handoff between channels.

Self-Service that Anticipates Intent

When considering new healthcare plans or initiating interactions with insurance companies online, members expect to have self-serve options for answers and basic information. This is particularly true of millennials, one-third of whom say optimal self-service is what they look for in a great customer service experience.

The healthcare industry is rife with opportunities to drive self-service. For example, when comparing various healthcare plans or determining potential deductibles, technologies such as a chat bots or virtual agents can provide accurate answers to common questions at scale, empowering consumers to find the information they need independently and easily.

Members should also be able to check claim status on their own, online or over the phone.  For standardized questions, such as, “How long does it take to process my claim?” payers can reduce the higher costs of phone and email support by implementing self-serve technology that gives members the information they need, deflecting commonly asked questions from the call center. For members who prefer using the phone, payers can achieve the same results using interactive voice response (IVR) systems with natural language speech technologies. This technology lets users say what they need and receive accurate answers instantly, and avoids the famous phone trees that give customer service a bad name.

No matter the request, the underlying technology that makes self-service possible must anticipate a person’s true intent, so that finding information and enacting key purchasing decisions becomes much easier. For instance, if a member is comparing deductibles online, customer service solutions can predict that person’s next likely action, and proactively provide related information such as bridge deductible options. Anticipating needs can help companies better identify prospective members and offer them the necessary assistance for conversion. This strategy also manages overall costs by streamlining interactions over time, ensuring complete resolution happens more quickly and requires fewer resources.

Effortless Transitions

Due to the sensitive and financial nature of healthcare coverage, there will be instances when consumers need additional help beyond what an IVR, virtual agent or chatbot can provide.

For instance, if a member has a very unique or specific scenario to discuss and it can no longer be handled through self-service, that member can be smoothly transitioned to a live agent who already understands their context and intent. The same goes for members using speech self-service over the phone, who can be routed to live voice agents who already know the purpose of their call, and don’t ask for information to be repeated.

The key is whenever members are transferred from self-service to assisted-service (i.e., from self-service to assisted-service), no critical journey data or context should be lost during the transition. This could include information like a member’s name, account number, or progress along their resolution journey. Effortless transitions both reduce average handle times (translating to profitability for providers) and deliver a complete and personalized customer experience for members.

If a member is inquiring about a recent change in her deductible and needs additional assistance, when she moves from a virtual agent to a live one, the latter should be able to say, “Hello [name]! I see you’re trying to learn more about a recent change to your deductible. How can I help?” To properly handle every interaction, virtual agents must also have the intelligence to determine when members’ queries have become too complex and require human interaction. While we’ve seen a lot of hype around the potential of chatbots to transform customer service, not all bots are created equal, and it’s important that any self-service solution can transition easily and effectively to human assistance.

Just as an apple a day keeps the doctor away, a top-notch customer engagement strategy keeps members happy and avoids having them jump ship to a competitor. To establish loyalty and advocacy with members, healthcare providers must focus on nurturing relationships with members over time. A major component of this is a frictionless service experience that can help members achieve their goals and satisfy their needs with minimal frustration. The shift toward consumerism has only just begun for healthcare, so businesses that move quickly to adapt will reap the benefits.


Bobby Brown // Bobby Brown is Vice President and vertical leader of [24]7’s Healthcare practice. In that role he has responsibility for developing, and executing the 24/7 strategy and approach to the Healthcare ecosystem, designing specific digital engagement solutions that enhance how members, providers, and health plans interact.

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