The Road Ahead


How Interaction Analytics Helps Health Plans Serve Customers, Contain Costs

With open enrollment on the federal and state insurance exchanges just beginning, the nation’s eyes are on the consumer-facing portions of the health care insurance infrastructure – the websites. While the national news organizations focus on the functional success or failure of these sites, there’s much more involved in managing a successful open enrollment period for the insurance companies.

After a rocky first year under the Affordable Care Act, the healthcare market continues its shift to a more consumer-driven model. With federal requirements specifying many of the coverages that plans must provide, plan differentiation has shrunk to the point that many consumers are basing their choice of payer on price and customer experience. Payers are responding to lessons learned from enrollment encounters of the past year by focusing on improved customer experience and reduced customer effort to increase and retain plan membership. Understanding the customer’s needs is critical to effective process improvement, and companies are looking for every advantage to provide customers with the best possible experience, while simultaneously keeping operating costs in line. Use of interaction analytics can be a valuable tool for achieving this goal.

Confusion is the Still the Name of the Game

As millions of people begin the annual task of shopping for coverage, there is still a huge amount of confusion in the consumer marketplace. Technical glitches and 2014’s conflicting information are still specters in the mind of many consumers, and year-over-year changes to national insurance guidelines perpetuate the apprehension many feel as they face this enrollment period. It’s no surprise that the biggest challenge healthcare companies face again this year is explaining policy coverages and guidelines to existing and potential new members in the clearest way possible.

A confused member is likely to be a dissatisfied member, and these individuals are most prone to reach out to the contact center for assistance – particularly when the self-service websites do not meet their needs. As inbound call volumes increase, so do handle times. Customers must wait longer for answers, or call back more than once. First call resolution rates fall, and the resulting drops in customer satisfaction from all these factors can lead to both reduced enrollments and churn among existing customers.

Measuring member confusion and identifying the source is a logical response, but one that consumes significant amounts of time and money from plans that have little to spare. Meanwhile, consumers are making decisions now, and plans need to be able to respond to frequently asked questions, either through changes to marketing materials or by preparing agents to address the issues surfacing in calls. Interaction analytics provides the insights to answer these challenges.

Insights From Interaction Analytics

Interaction analytics delivers insights and access to key information that is being captured by the contact center or sales center. By using language, sentiment analysis and several other factors to determine what constitutes a confused or dissatisfied call, insurance companies are able to quantify the number of these calls they are experiencing, and drill down into the calls to determine, at an actionable level, the root causes driving them.

Armed with this information, health care executives are able to make adjustments to literature, websites or other materials so consumers can more readily find and understand the information they need. Lessons learned can also be applied to agent training, making sure that agents are prepared to explain key policy details or respond to trending questions from potential enrollees. Interaction analytics can also provide insights into the factors that are most important to members when purchasing their plans. This data is collected directly from the conversations between members and agents, delivering specific, unbiased insights into the attitudes of the customer.

Metrics to Drive Improvement

In addition to delivering customer insights, interaction analytics delivers the ability to create team performance metrics that can be trended over time and monitored on a continuous basis. A plan is often rewarded or penalized for how they are servicing their members, based on standards set by their own parent organization or by government regulations such as Medicare STARS ratings. While plans anxiously await their yearly results, they often lack a way to understand how their contact center personnel are performing throughout the year so they can take steps to continuously improve. An interaction analytics solution that allows the organization to move beyond targeted listening and create metrics that align agent and team goals with organizational goals provides a distinct advantage in this competitive environment.

A Map for the Road Ahead

As the movement toward consumer-driven healthcare progresses, the need for information – both on the consumer side and the plan side – will dramatically increase. Consumers will need information to make informed decisions and payers must ensure they’re providing the right information, in the best possible manner, in order to maximize enrollments and maintain member satisfaction. Interaction analytics can provide a unique road map for organizations that ensures they have the proper knowledge to deliver the facts and options their customers demand, and maximize the performance of their teams as well.

Categories: Performance Management