Healthcare customer service gets personal

Bill Marshall,

An industry in need

Quick! Think of a great customer experience you’ve had with your healthcare insurance company. Go ahead, take a moment. I’ll wait…

Perhaps you can recount one. But for most Americans, they’re likely to instead have stories of frustration with a health insurance company. The American Customer Satisfaction Index (ACSI) in their 2018 Customer Satisfaction Benchmarks study scored health insurance 40th in a list of 46 industries. In their more focused ASCI Finance and Insurance Report 2018, ASCI notes

Health insurance is, by far, the most problematic and least satisfying category in the sector, in part because it is also the most complicated and controversial. It is much more difficult to deliver high-quality customer service and assess value for health insurance compared with other financial services.”

Understanding what health insurance customers need is the first step for payers to improve customer satisfaction scores. Don Peppers, a respected author and co-founder of the customer-centric management consulting firm of Peppers & Rogers, provides a great summary of member needs in his article, Delivering a Frictionless Customer Experience in Healthcare Insurance, first published on LinkedIn, and then republished by Inc. magazine online. Pardon the pun, but he peppers the article with a series of bullet points about personalized service. His point is clear – you have to know your customer to get personal with your customer.

The pressure to get personal

Consumerism, market forces, and the personalized medicine wave, among other influences, are all positively pressuring the healthcare industry. For example, personalized medicine, by using genetics, genomics, and Big Data, is moving healthcare beyond the familiar one-size-fits-all models of prevention, diagnosis, and treatment. Likewise, the intelligent, contextual use of claims data, medical data, and social determinants of health now allow payer customer service teams to truly personalize their interactions with members.

And, this matches the desires of the members. As consumers experience stellar engagement with high scoring firms like Amazon, Apple, and American Express, members now expect high-quality customer experiences with their health plan. They want connected, personalized, and frictionless engagement. Whether by phone, chat, online, social, or via mobile channels, members expect to be known and well served.

Make personalized service the norm

Rethink the service model across your customer service operations by moving to a model focused on delivering personalized journeys for each customer. Internally, this requires moving beyond traditional metrics such as average handle time and first call resolution. Focusing on personalized service requires new metrics such as call avoidance and member effort. Member effort gauges the question put forth to the member, “How much effort did you personally have to put forth to handle your request?” This is hugely important to measure and improve upon given ASCI’s comment about health insurance being “the most complicated and controversial.”

To address the complications and controversy and keep the member from expending great effort just to get the answer to seemingly simple questions, health insurers need two key capabilities to make personalized service the norm.

  • Real-time, omni-channel AI that can work across every customer channel and touch-point to recommend the right actions to take and conversations to have while continuously learning and optimizing each interaction – much like a ‘brain.’ It needs to be a centralized decision hub that knows, regardless of channel, when to recommend a service, suggest a care program, or offer a new service in context, understanding a member’s context: existing relationship, recent interactions, personal situation, and risk tolerance.
  • End-to-end automation with robotics; too often “case management” in customer service is reduced to simple tracking and ticketing. Today’s service leaders need automation that cuts across existing systems and silos to drive work to completion.

Forward thinking health insurers are applying these capabilities one customer journey at time.

In so doing, they are enabling their organizations to get personal with healthcare customer service, while driving down operational costs and meeting the high expectations of their members!

Learn More

  • Read the eBook, “Why healthcare needs to put service first” and learn how to take a proactive, personalized approach to customer service.
  • Watch how Anthem is creating next-gen, customer-centric service.
  • See how Pega helps organizations automate tasks and processes to deliver relevant, accurate, outstanding customer service every time.
  • Get the results from Pega’s recent survey of more than 2,200 healthcare consumers and business decision makers on the topics of communication, accessibility, and technology.
  • Discover how Pega for Healthcare helps organizations personalize engagement for better outcomes.

Tags

  • Industry Group: Sanità
  • Argomento: Servizio clienti
  • Sfida: Servizio clienti

About the Author

William Marshall, Pega’s director and Healthcare/Life Sciences principal, has over 25 years of experience advising healthcare organizations on the most effective use of technologies, including CRM, care management, revenue cycle, and AI to improve customer engagement and operational efficiency.