Secrets to Better Health Plan Group & Member Engagement 


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Secrets to Better Health Plan Group & Member Engagement

  • Choosing a health insurance provider or a personalized healthcare plan are two of the most important decisions a person or a company can make. After all, when you choose a provider and a personalized health plan, you’re handing over your sensitive medical data and trusting your insurer to help finance the medical care you need and, in some cases, can’t live without.
  • It’s no wonder, then, that individuals seeking health insurance plans and companies seeking group policies for their employees have started to demand a higher level of service and a better overall member experience. And they have a lot of options— on average, consumers can choose among 5 insurers and 88 plans in 2023 within the U.S. health insurance exchanges. Given the landscape, it’s no surprise that health insurers have started to look for ways to improve member engagement and long-term member loyalty.
  • For health insurers looking to enhance their services and increase member satisfaction, consider these keys to increase both member and group engagement.

Keys to Member Engagement & Personalization

  1. Have an Immediate Impact on New Members

There’s nothing quite like a good first impression to set the tone for overall experience, and for health insurance providers, that first impression typically happens during new member onboarding.

The first two pieces are straightforward: No one likes a long or needlessly complicated onboarding process, whether on the member or the provider side. An uncomplicated way to make onboarding faster and more efficient is to use a customer relationship management (CRM) system to automatically create, assign, and track all tasks and information associated with plan onboarding.

By using automation to guide new members through onboarding, health insurance providers make it easier for employees to collect critical member data — while simultaneously freeing them up to focus on other, more pressing tasks — and save members the effort of filling out page upon page of onboarding paperwork.

In terms of transparency, a CRM solution also makes it easy for carriers to maintain open lines of communication with new members throughout onboarding so that member questions and complaints are addressed early and often. It can help set you apart from other providers when, in fact, 41 percent of U.S. online adults with health insurance wish their health insurer would do more to help them understand their health care benefits.

A quality CRM will outline the steps of the onboarding process and flag opportunities for member engagement, such as notifying a member of their progress each time they complete a step or sending a follow-up email when the organization is waiting on information from a member or group administrator.

  1. Deliver an Exceptional Member Experience

Taken as a whole, the insurance industry has been one of the last to get in on the concept of member-centricity but, now that it has, it’s doing so in a big way. In the health insurance industry, self-service and personalization should be at the top of every insurer’s list when providing an exceptional member experience and increasing health plan member engagement.

A CRM system can store all member data in a centralized repository and use it to create individual member profiles. That way should a member decide that they require assistance from a live service representative, the rep can easily pull up that member’s profile and provide personalized service based on their needs. Compared to when member data was spread out across disparate systems, a CRM saves time for reps and members alike.

Think of the value on the customer-service side. Reducing time and resources spent digging for information makes everyone happier— customers, agents and the bottom line. When a user interacts with a customer service touchpoint, the agent can quickly respond with context to the customer because the CRM has centralized the data, identified the customer, detailed their account history and any relevant conversations they’ve had with your business, and suggested next best steps. Everyone becomes more productive in their role.

The health plan member of today is independent, on the go, and expects their insurer to accommodate their busy lifestyle — that means being able to access their policy and plan whenever, from anywhere in the world and handling issues without ever having to pick up the phone to contact a representative. Health plan providers can use CRM technology to build member self-service portals, which a member can log into to view their benefits, outstanding bills, claims history, and so on.

The consolidation of member data in a CRM system is also invaluable in that it enables sales teams to engage in more effective upselling and cross-selling by providing personalized offers to members. Since CRMs offer a “member 360” view, sales reps can see which products members currently have, which ones they don’t, and which ones they’d be well suited for.

Furthermore, outreach personalization efforts can be supercharged when a CRM system is infused with AI-based analytics that allow you to segment customer groups. For example, a member with young children requires different options than someone close to retirement. With personalization, companies create outreach at scale that educates and motivates members to self-manage their policies and programs. This approach can lead to better outcomes while reducing the total cost of care.

For example, a CRM can analyze member and product data and show a sales rep that one member — let’s call her Tara — is aging out of her current plan. A sales rep can reach out and discuss Tara’s new plan options and retain her business for her next phase of life. It’s a win-win situation: Tara walks away from the experience feeling like her health insurer really understands her needs, and the company profits from her business.

  1. Stay in Touch at Every Stage of the Member Lifecycle

Remember those open lines of communication we talked about during onboarding? They need to remain open long after onboarding is over. In fact, one important way for health plan providers to increase member engagement is to maintain consistent contact throughout the member lifecycle; this can be as simple as sending a congratulatory email to a member after they’ve had a baby or notifying them of drug recalls or formulary updates based on their prescription history.

The healthcare consumer experience is an important one, and health insurers should be mindful to meet each member at their level — that is, to contact them through their preferred channels. Although there are many touchpoints to choose from — phone, text/SMS message, email, social media, live chat, and so on — most members have a mode of communication with which they’re most comfortable. Insurers can use their CRM to track member communications, such as how many times they’ve logged into the member portal for self-service or how many times they’ve called into the member service hotline, to get a read on how they prefer to be contacted.

  1. Show Members That You Value Their Time

There’s nothing more frustrating to members than feeling like their service requests or complaints have been unaddressed, but the reality is that health insurers’ call centers are often inundated with a higher volume of requests than they’re able to keep up with.

To prevent these requests from falling to the wayside and to show members that their time is valued, health insurance providers need to establish internal processes and procedures to improve member service and call center efficiency and then implement them through their CRM. For example, a health insurer could create service level agreements that set expectations for response times based on the mode of communication — say, 4 hours for a phone call, 24 hours for an email, and so on.

Maintaining consistent communication is another way to reduce call center volume and to make members feel valued. Rather than wait for something to go wrong to talk to members, insurers should provide regular updates and periodically check in to improve member engagement and resolve issues before they occur. Member self-service is another great way to reduce call volume; the more information an insurer can provide members to help them find answers to their own questions rather than call in and speak to a live person, the better.

For those calls that do inevitably come through, service reps should use member profiles pulled from their employer’s CRM to better understand each member’s individual needs — that way, they can get to the heart of the issue and on track to a resolution that much quicker. A CRM can also provide valuable analytics around call center data, such as which plans get the most benefit questions, for member education and member engagement.

The application of conversational AI and generative AI in the world of health care payors and providers stands to revolutionize the way they interact with potential customers and members. Anticipatory customer service becomes possible, and agents are more able to have personalized conversations, opening doors to better engagement and driving loyalty.

AI tools can analyze conversations, and offer feedback and resolutions based on what a member is saying, all in real time. These helper features go a long way toward making the system easier to use for reps and can reduce the time it takes an agent to get the information they need.

  1. Pair Service Representative Training with Technology

Many health plan member service teams find that they struggle with the seasonal volume and complexity of service requests; this isn’t a reflection on the quality of individual representatives or the team, but rather on the training they received prior to fielding requests and seasonality of the business. Most service rep training focuses on the basics of quality member service — effective communication, problem-solving, resourcefulness, patience, and so on — but fails to factor in technology.

A representative can provide impeccable member service but, without being taught how to use their employer’s CRM system, will find themselves limited in what they’re able to accomplish. Therefore, health insurers need to invest in comprehensive training that accounts for their existing IT infrastructure, organizational change management, and basic industry best practices to be effective.

AI-infused chatbots can also improve customer service by offering personalized and proactive outreach, visibility and transparency, and round-the-clock support. They can be trained using AI to swiftly address routine inquiries, provide policy information, answer routine questions and even guide customers through issues. This not only increases customer satisfaction but also reduces call center activity, which frees up resources to handle more complex tasks — boosting efficiency and cost savings.

  1. Identify Opportunities for Preventative Care

The chances of a patient being readmitted after a recent emergency hospitalization are high, which poses a significant problem for health care and health plan providers alike. As a result, more health plans are looking into ways to develop loyalty programs that use wearable devices to track members’ health, encourage better behavior patterns, and implement preventative care.

Health insurers can incentivize this behavior by offering members rewards, such as gift cards or savings, for making health-conscious choices. In the end, everyone wins: Members save money and benefit from their healthy choices, and insurers increase health plan member engagement, ensure member loyalty, and reduce the amount of money they pay out on claims.

Keys to Group Engagement & Personalization

  1. Make the Right First Impression

Just as with individuals who are looking for a new plan, a company seeking a group policy for its employees expects the onboarding process to be simple, expedient, and transparent. The important thing for health insurers to remember is that while individual experience is still extremely important, there must be consideration of the collective experience.

The point of contact for this experience starts with the human resources (HR) representative who is both a member and the group administrator. Whenever the HR rep contacts the insurance carrier, they’re not just addressing their own personal insurance, they’re addressing all the group’s collective concerns.

Right out of the gate, the insurer needs to understand the role of the HR rep and make sure they feel supported as the group administrator. The first part of this support is to digitize the onboarding process so that members can easily enter their own data through a portal. This must be a modern, seamless process that offers step-by-step assistance to members as they enroll, something that’s beyond just logging all their information into a spreadsheet.

The more the group administrator’s time is valued by having readily available resources – like immediate access to plan data and FAQs – the better the first impression. With a good enough impression, the administrator will be an advocate for why the plan should be renewed next year.

  1. Provide the Best Group Experience Possible

That positive impression must also extend to all the individual group members. Busy employees don’t want to spend time jumping through hoops by filling out forms and requesting needed information. And the last thing the HR representative wants is to get complaints from members about their negative insurance experience.

A CRM can allow insurers to support customization and personalization for the group by providing easy-to-access portals and readily available information. For larger groups, it’s also worth considering the use of low-code or no-code solutions to develop hyper-personalized apps that cater exclusively to that group.

Using a low-code application like Microsoft’s Power Apps can allow the health payor’s end users to quickly customize the experience for those specific members – no matter their skill level in coding. This also has the added benefit of taking some of the coding burden off the health payor’s development team, freeing them up for more important tasks.

Check out our podcast, where Hitachi Solutions industry experts explore the low-code Power Platform and how health payors and providers are using it today to help drive everything from compliance to productivity to employee retention.

  1. Ensure Constant and Informed Communication

Health plans can better appeal to groups by maintaining consistent and direct communication throughout the member lifecycle. It’s important to offer multiple forms of communication, considering that not every group member will have access to the same technology or share the same preferences.

One of the most effective ways to provide relevant communication is toarm the HR representative with the most relevant content to pre-emptively address issues and questions.An effective way to do this is byemploying AI tools like Natural Language Processing (NLP) to thoroughly review all the customer service data to determine what are the most common pain points and frequently asked questions.

For example, if the majority of the questions being fielded across groups are about how to find an in-network primary care provider and what the co-pay for a plan is, then it’s imperative that information is distributed to the HR representative to either directly address those concerns or show where in the portal members can go to have their questions answered.

This type of informed communication should also be utilized in all forms of direct communication to members, including emails, newsletters, text/SMS messages, social media, and live chat.

Perhaps the best benefit for payors is that this level of insight, when informed by AI, can help to lower call center volume, which will reduce wait time for all members and increase customer satisfaction.

  1. Show Appreciation by Considering Concerns Across Groups

Insurers should be in regular communication with HR reps and groups to provide updates, check in on member engagement, answer questions, and resolve issues. Part of that process should entail looking at all the groups across the different industries the provider serves and aggregating the available data.

Here’s where generative AI can help. Generative AI can simplify analyzing large amounts of structured and unstructured data to identify demand, benefit trends, and relevant activity that can help agents identify pain points and express value in customer terms. Microsoft is integrating AI into its suite of products – branded under the name Copilot – meaning that generative AI capabilities can be turned on in Microsoft CRM systems like Dynamics 365 Sales and nothing needs to be done on your end.

This can help to provide further insights into what the members of different groups value in their service plans. Those insights may help to prioritize different plan offerings, or present members with add-ons they’re likely to find appealing (like options for pet insurance). For example, if the payor is seeing an increased demand for childcare services within a specific industry, that could inform the communication outreach to other groups within that industry about updating family plans.

Health payors should also look at the concerns of administrators from across different groups to see what their most consistent issues and questions are. This can help with the onboarding process for new group administrators while also providing timely updates for existing ones.

  1. Technology Should Showcase Services and Member Experience Training

Modern technology should be a key selling point of provided services and how member service representatives are trained to ensure that health plan members’ questions and concerns will be handled efficiently. Groups need to be assured that their members are receiving accurate and timely information, that their personal data is secure, and that the customer service reps are adequately trained in the appropriate software, infrastructure, and the employer’s CRM.

Payors should be transparent about the training process and make it a talking point that the call center is the most important area of member engagement. Payors should make it a point of pride to highlight customer service stats, detail the training progress, highlight the areas that utilize modernized software, security systems and technology.

Security is imperative for any digital health care solution and agents need to be able to communicate and demonstrate to customers that their personal information is being held and used securely and transparently. Hitachi Solutions’ Identity Verification for Engage gives agents that clear path, walking them through the required questions and steps to ensure security is at the forefront of their client interactions.

Call center agents are guided through the identity verification process, and clients can configure the solution to align with their verification procedures. All the details are automatically captured in an audit record which reduces call time, streamlines auditing and transparency, and opens new potential for reporting on trends that may indicate fraudulent activity.

Once verified, Identity Verification for Engage for Health Plans provides complete account status including open items and work orders, as well as on-screen call flows that agents can use to address member issues like gaps in care or missing information. It’s a visual solution to effectively manage and foster profitable relationships.

  1. Offer Group Benefits and Rewards

Member engagement and personalized healthcare are important, but it’s also crucial to target the group. Loyalty and wellness programs not only provide incentives for employees to better their health, but they also offer easy and efficient ways for individuals to connect with each other as a company.

Some organizations have even used these kinds of programs as “friendly competition” between members or ways to raise funds for a particular charity, which further enhances the cohesive group dynamic. 

These kinds of programs are also financially beneficial for all involved:

  • Members save money and benefit from their healthy choices
  • Companies see fewer employee sick days
  • Healthy and fit employees are more focused and productive
  • Reduced healthcare and insurance costs for the employer
  • Insurers increase health plan member engagement, ensure member loyalty, and reduce the amount of money they pay out on claims

While the basics of wellness and loyalty plans may be consistent across the board, specific details and incentives can be customized for larger groups, to ensure that they’re relevant for the largest number of members.

Member & Group Engagement Success Stories in the Making

At Hitachi Solutions, we have decades of experience helping health payors and plans find new and innovative ways to leverage their modern technology stack. Whether it’s identifying the coverage that best meets the needs of personalized healthcare or using members’ browsing history to deliver key analytics-based insights, our Engage for Health Plans solution harnesses the power of Microsoft Dynamics 365 so that health insurers can provide the best service possible to new and existing members. Start your journey to superior health plan member engagement by talking to one of our representatives today.