Thanks to the Affordable Care Act, there is no longer any such thing as “business as usual” in the healthcare industry. While many are waiting to see what is going to happen before acting, some are already moving to learn the new market realities and capitalize on new opportunities. Nowhere is this more true than in the arena of customer engagement. In the payer space alone, Eventus is seeing six major trends occurring simultaneously, all of which have significant ramifications or impact on customer engagement strategies.
With the launch of public healthcare exchanges, many payers that have historically sold to groups are now selling to individual consumers. Furthermore, a growing number of large employers have announced they are turning their employees over to public and private exchanges for their health insurance benefits. As group revenues shrink, payers need to find ways to replace this revenue if they want to keep growing.
As they target individuals, traditional wholesalers are becoming retailers who will need to support radically different customer journeys. Modern, digital-age consumers are highly engaged and informed about the brands they choose to support. These consumers will surely demand unprecedented provider pricing transparency. Realizing they have much to learn in a short period of time, some health plans are hiring customer care expertise from other industries.
In an e-Commerce world where every payer’s price list is public knowledge, consumers tend to focus on price when making buying decisions. To differentiate and thrive in this highly competitive environment, health plans will need to listen to their customers better, design plans and customer journeys optimized for specific segments, then educate the market on their advantages.
The focus on price will also put a focus on cost as firms strive to lower costs so they can compete better on price. While large health plans run excellent contact centers today, they will be pressured to reduce costs while not compromising service quality. Fortunately new technologies including SaaS applications, agent desktop optimization and multi-channel communications can increase agent productivity while reducing costs. Furthermore, the agent-at-home operating model improves quality, reduces costs and support geographic restrictions such as all home agents living in-state.
As Medicare expands, Medicare players will need to be able to live new Medicare margins. Also, new regulations on profitability, MLR and ALR are designed to drive additional cost savings. Finally, the government is putting many restrictions on plan design. Plans will need to respond to these challenges, as government funding of healthcare insurance is expected to rise from 50% today to 70% over the next few years.
Payers large and small are forming joint ventures or even tighter relationships with providers to create Accountable Care Organizations. Doing so means these companies now own the entire end-to-end customer journey including scheduling, wellness and post-care follow-up. In addition, both payers and providers are expanding focus on wellness and population health management programs that will require significant proactive outreach.
Since the ACA became law, the healthcare industry has seen increased acquisition activity; large payers are getting larger, small providers are getting rolled up, and payers are merging with providers to form ACOs. Whenever a merger takes place, significant opportunities exist for contact center technology and operations consolidations that will not only reduce cost, but also streamline customer journeys.
With the recent launch of HIPAA-compliant and certified cloud computing environments, healthcare organizations can now get the same financial and operational benefits from SaaS and other cloud-based applications as those in less-regulated industries. Specifically for health plans, per user/per month Saas pricing models can dramatically reduce software licensing costs for open enrollment usage spikes. The healthcare industry has traditionally been a relatively conservative adopter of new technologies. However, when it comes to the cloud, healthcare is actually adopting these technologies more aggressively than other industries.