A Glimpse into the Future. Interaction Analytics Helps Plans Navigate the Affordable Care Act


The Impact to Insurance Companies

There’s no doubt about it, the Affordable Care Act (ACA) is in full swing.  You can’t turn the news on for more than 60 seconds without seeing a story about its effects and how the beginning stages of the implementation are taking shape.  However, I’ve noticed something interesting about the stories.  Nearly all of them are coming from the perspective of the consumer, versus the perspective of the health insurance plans, and their worlds are being rocked just as much.  In fact, I recently attended a major industry event and the effects of the ACA were definitely the primary topic.  As millions of people are entering the Exchanges, or even just switching plans, it’s becoming more imperative that health insurance companies are communicating with members in the best possible way.  The member lifecycle must be carefully managed to ensure the best possible experience is delivered while the operating costs are kept in line with new industry regulations.  Interaction analytics is the key to making this happen.

Confusion is the Name of the Game

Given the avalanche of changes, one of the biggest challenges healthcare companies face is explaining those changes to existing members or potential new members in the clearest manner possible.  A confused member is often a dissatisfied member, and if they’re confused, they’re probably reaching out to the contact center to get answers to their questions.  This can drive an increase in call volumes, add to handle times, decrease first call resolution rates, and the drops in satisfaction can lead to both churn and lower enrollments.  But measuring member confusion and getting to the heart of what’s causing it can consume significant amounts of time and money for plans that have little of either to spare.  Surveys shed some light, but their data is often skewed as often only the most satisfied or dissatisfied respond, and the data takes a long time to collect and process.  Meanwhile, consumers are making decisions now, and plans can’t afford to continue to put out information that is confusing or insufficient in describing their products and benefits.

Enter Interaction Analytics

Interaction analytics provides companies with the behavioral data that they didn’t previously have access to by connecting them directly with the information contained in the interactions being captured by their contact center.  By using several factors including language and sentiment analysis to determine what classifies a confused or dissatisfied call, insurance companies are able to quantify the number of these occurring and then drill down deeper to determine what is specifically driving them.  Armed with this information they’re able to make corrections to their literature, websites or other marketing materials so consumers can more readily find and understand the information they need.   It can also provide details into what is important to members in purchasing their plan. And unlike surveys which typically combine numeric and freeform questions that are not always completed, this data is collected directly from what the member is telling the agent during the interaction.  It’s unbiased and can be tied to specific events.

Measure to Improve

Another advantage interaction analytics provides is the ability to create metrics that can be trended over time and monitored on a continuous basis.  Oftentimes, a plan is rewarded or penalized for how they are servicing their members.  It can come from standards their own parent organization sets or even by government regulations such as Medicare STARS ratings.  I can’t tell you how many times I’ve watched plans anxiously await their yearly results, but lacked a way to really understand how they’re doing throughout the year so that they can continuously effect positive change.  Having an interaction analytics solution that allows you to move beyond targeted listening and create metrics and measurements that align to your organization’s goals is an important factor when selecting a vendor, and one that should be carefully studied.  For example, healthcare companies will want to make sure they’re grading agent performance against 100% of their interactions, and that they’re confident they’re capturing each time a specific type of event has occurred that they’re measuring the agent against — not just focused on 2 quality monitors per agent per week as some health insurance companies do today.  Simply finding examples of where an agent handled an enrollment call is helpful, but won’t tell the company if the agent presented the information correctly every time there was a potential member who was eligible for a qualifying plan.  Or are agents resolving claim calls the first time, every time, in order to avoid repeat calls and future member dissatisfaction? In order to truly make impactful change, it’s important to have a solution that allows for this type of analysis.

A Look Towards the Future

While no one has a crystal ball to see exactly what the long-term effects of ACA will be, the short-term ones are pretty clear.  The need for information, both on the consumer side and the plan side will dramatically increase.  Consumers need information to make informed decisions and health insurance providers need information to ensure they’re providing the right information, in the best possible manner, so they can maximize enrollments and maintain satisfaction among current members.  And they need to gather this information in cost effective ways with the speed and agility the market is demanding.  The smart plans?  They’ll look into the crystal ball and see interaction analytics in their future.


(Photo Credit: Crystal Ball by Jason via Flickr)

Categories: Performance Management