Before the Affordable Care Act (ACA) became law, health plans relied on an employer-centric model that was focused entirely on groups rather than members.
Now that health insurance is within the reach of many more Americans and individual plans are common, payers need to focus on each member in addition to the group.
This shift comes with significant challenges. Cumbersome manual processes that worked with groups to track leads, sales and marketing campaigns, along with siloed databases used to track utilization and service issues, are not scalable to handle tens of thousands of individuals effectively. They also will not provide the holistic analytical picture needed to deliver excellent service.
These new healthcare consumers are less tied to their health insurer and more knowledgeable about alternatives. Maintaining member loyalty is a strategic imperative and key to that is increased, effective member engagement. With the proper tools and processes in place, this can be the year to make significant inroads with engaging patients.
Making Data Work
Insurance companies looking to make themselves more competitive are required to deliver an optimal customer experience as a differentiator. This extends beyond providing a good experience when a member initiates contact. To be proactive, the health plan must truly understand the individual, what they are interested in, how they engage, what plans they are interested in and how they purchase.
Understanding what perspective members look like, and what their persona is, helps insurance companies start to plan and strategically position their products and services to address the needs of those personas. Personas are the core of an analytical model for sales and support and are essential for planning the future. They give insight into the customer and the business as well as help answer questions, including are the right products being offered to potential clients? What products are best bundled together? What is the journey that the customer takes to make a decision?
The data needed to drive these analytics has to be collected today. Analytics cannot be simply turned on one day and provide predictions the next. The results of predictive models are only as good as the data that is provided to them to analyze. As insurance purchasing is an annual process, the sample size for purchasing data is low, and thus several years of data are necessary to drive the proper conclusions. If high-fidelity analytical models are desired at any point in the future, then an organization needs to make the collection of as much behavioral, purchasing, utilization and relationship management data as possible a high priority now.
Delivering Transparency
It is critical to understand how to leverage technology and processes to eliminate data barriers and better integrate disparate systems, member health data and preferences to provide a unified, transparent view of the customer and foster a seamless member experience.
Traditional models do not allow for this level of transparency. Most insurance companies have different teams that sell to and service members within certain size groups. These teams operate in their own lanes, without sharing data. Worse, many departments have their own unique technology, including CRM systems, with no visibility between sales, marketing and support. So, all teams work with only a partial view. Carriers should strive for operational and analytical transparency that allows visibility of data across those traditional internal boundaries so that they can make better decisions that optimize performance across business units and functions.
Having access to full customer information across departments makes sure everyone is working off of the same information, giving those servicing customers a holistic view of the members. This leads to a more consistent experience across the organization.
Tools to Assist
Connecting a technology platform across your various data sources is critical for many reasons, including adding transparency across departments, enabling standardized responses to customer interactions and collecting data for key decisions. Utilize sales and service data to drive your customer experience across the entire lifecycle — increasing and improving touchpoints with your members provides opportunities to build loyalty.
CRM systems aid organizations with data collection, organization and transparency. One best practice is to integrate the CRM with multiple front- and back-end systems to inform and accelerate data collection. This makes both the sales and service process more efficient as well as sets the table for future analytical capabilities. Properly built, a CRM solution with seamless integration transforms traditional customer experiences into new, lasting and meaningful connections with current and prospective customers throughout the member journey.
Payers should look at technology that eliminates manual processes, which slow progress down. By implementing marketing, sales and service automation, the relationship between insurance provider and member becomes less transactional and evolves into a nurtured relationship. This leads directly to better member retention. Operational efficiencies and synergies are gained by enabling the sharing of data across the enterprise, streamlining all customer interactions during their lifecycle. Research shows that many member renewal decisions are made before open enrollment starts — that decision is based entirely upon the member experience and value they have already had during the year.
One final key to member engagement is anticipating and meeting members' needs. The modern marketplace with companies like Uber and Amazon deliver a level of convenience and service that consumers have come to expect.
By Donald Searing, Ph.D., Senior Director of Product Evangelism for Colibrium
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