The shift to a value-based system and the passage of the Affordable Care Act changed the fundamental dynamic of healthcare purchasing and delivery. The establishment of marketplaces, which allow individuals and small businesses to compare standardized coverage options, placed unprecedented power in the hands of healthcare consumers.

The modern retail and service landscape, forged by the likes of Amazon, Uber, assorted financial services and others, has seen a revolution in consumer experienceone that is highly personalized, includes multiple touchpoints, and is equipped with a strategic mix of self-service and live-agent options. The empowerment that comes with access to digital technology has fundamentally changed how customers get serviced today.

Todays consumer dont want to have to climb a companys phone tree for more information. They want access to real-time information online. A customer who has no problem texting with a vendor for an hour, may give up in frustration if theyre put on hold for 10 minutes.

Like their retail brethren, healthcare insurers also have invested deeply in multichannel and engagement technology. Some are even tapping the customer experience as a business metric. An intensely loyal member is an advocate who creates the perception of reliability and credibility in the marketplace.

However, many healthcare insurers fail to properly integrate their engagement and personalization capabilities. Thats because information technology alone is not going to successfully capture the attention and loyalty of consumers. However the member chooses to engage with the insurer, the plan must be ready to meet (and even anticipate) the members needs.


The front end of consumer engagement

One of the key disconnects on the front end of customer service is understanding how to use multiple channels of engagementand how consumers feel they should seamlessly flow together. For example, simply having a social media handle does not necessarily mean that you are servicing customers. Most insurance companies tend to use it for marketing, but only through integration and strategy does it become a viable service.

Health insurers have traditionally had relatively few touchpoints with members and so fewer opportunities to build loyalty. Therefore, it is critical to create opportunities to engage with members and build affinity whenever a touchpoint occursfrom enrollment, onboarding (how employees acquire new skills) and health plan education to appointment reminders and change-of-life events.

For example, millennial customers switch channels based on convenience, and they expect the next channel they choose to get them started where they stopped on the previous channel. Another expectation is responsive design to ensure that a brands website renders properly on every device irrespective of screen size.

Simply put, businesses should be prepared to meet their needs with self-service channels that help them get the right answer, fast. They need multiple channels with cross-channel integration, including self-service.

The manner in which insurers will accomplish successful touchpoints will be driven by factors such as the segment of the population. For example, members belonging to the fast-growing segment of Individual and family plans represent widely varied consumer preferences. Where one member actively initiates holistic care practices, another may actively resist routine preventative procedures. A young couple may be focused on family planning while a middle-aged member might be at high risk for cardiovascular disease. Tailoring member-specific service based on these unique circumstances and preferences is dependent on a robust data analytics platform within the insurer organization.


Focusing on the back end

Boiled down to its essence, the back end of this transformation seeks to answer one question: How do I tell a unified, integrated engagement story?

Your organization has multiple channels of servicechat, social, phone, but how integrated are they? Can a customer start a conversation on the phone, them move into text or chat and pick up exactly where they left off? Can they visit your website, read some content, and then start a chat anytime?

Digital transformation has changed the paradigm by which goods and services are delivered to consumers in myriad sectors. Yet, healthcare has been stymied by aging systems and a lack of health data integration, in part necessitated by patient privacy regulations. As a result, payersalthough in possession of a wealth of health-related datalack insight into members full history and preferences.

Therefore, it is critical to create opportunities to engage with members and build affinity whenever a touchpoint occursfrom enrollment, onboarding and health plan education to appointment reminders and change-of-life events. Tailoring member-specific service based on these unique circumstances and preferences is dependent on a robust data analytics platform within the insurer organization.

The backbone of a universal customer experience online

With the aggregation of member data, insurers gain the ability to evaluate and re-evaluate the customer lifecycle and the likelihood that members are in need of and will subscribe to additional services. Without the technology to integrate member health data and preferences, insurers will fail to meet consumers rising expectations for a seamless and satisfying experience, leaving members frustrated and difficult to retain.


The backbone of a universal customer experience driven by the web is a mix of self-help automation and live agents. For example, suppose a member visits your organizations website to learn more about health plans or obtaining insurance. What if, instead of static information, it was presented in a question-and-answer formatbacked by an intelligent knowledge base on the back endthat homes in on that members specific needs? If the next step of action is channeling the member to a live agent, like a nurse concierge service on a video chat platform, its done seamlessly so as to avoid having the member begin their query from scratch. This is an example of back-end knowledge and tying it in to a frontend tool.

One of the challenges in a digital experience is ensuring it is holistic. Consumers demand a consistent and seamless experience throughout the customer journey from the time they become aware of the brand, through the purchase cycle, and continuing to a quick and efficient service and support strategy.

The operations perspective

Regardless of the engagement methods used, the goal is to amass integrated member data to identify individually appropriate interventions to best manage their health. The total program must go beyond the member-facing channels to also provide integration with enterprise customer relationship management platforms.

From an operations perspective, such a platform would facilitate streamlined health plan set up, claims administration and member lifecycle management. All member participation information could be captured in a CRM that integrates with multiple backend systems to inform and accelerate the sales process. Back office agents could leverage the data captured within the platform to provide suggestions on how to balance member monthly costs with the best possible outcome; adjudicate or pay claims quickly and automatically; conduct root-cause analysis before a new plan is implemented; proactively look for claims-related savings opportunities and initiate recovery; and make the entire end-to-end process more efficient and accurate.

The healthcare insurer market is evolving rapidly due to increased regulation, and consumers, who are now able to make more choices for themselves, are demanding faster, easier digital access to their insurer as well as advanced wellness services.


Health insurance plans that embrace digital transformation of this magnitude stand to achieve substantial efficiency improvements in acquiring new members and providing services over the course of the customer lifecycle.

Anand Natampalli is vice president, global business development, for HGS, a provider of end-to-end business process services for numerous Fortune 100 health insurance companies and large provider organizations.