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Member service must aim toward individual experiences


Insurers must invent new healthcare solutions to be competitive in the market emerging under the Patient Protection and Affordable Care Act, according to a new report.

NATIONAL REPORTS-Insurers must invent new healthcare solutions to be competitive in the market emerging under the Patient Protection and Affordable Care Act, according to a report by Accenture. The report claims the most important solution will be attentive, personal customer service that is responsive to diverse and demanding member expectations.

In other industries, if customers don't experience good service, they vote with their feet, says Doug VanWingerden, senior executive for Accenture Health.

"They really can't do that today in healthcare, but potentially they can in the future," he says. "When many of these members get thrown into the open-bid exchange market, will they turn around and choose the payer again?"

Payers need to develop a strong customer service experience now, VanWingerden says, because such transformation takes time. Enrollment for exchange-based products is set to open just two years from now.

"Building that sense of engagement with the customer is the secret sauce for success in the post-reform era," he says.

Although payers have invested deeply in customer-service technology, the benefits have been "decidedly one-sided," the report states. Advancements such as automated phone attendants, live chat via the Internet, self-service on a Web site and mobile applications have lowered handling time-but have done little to improve the individual experience. Only 11% of survey respondents said the increased use of technology has improved their level of service over the past five years.


Meanwhile, most payers continue to struggle with service-experience basics. Customers reported such frustrations as having to contact customer service multiple times for the same reason, dealing with customer-service agents who cannot answer questions, and having to repeat the same information to multiple agents.

"Money spent doesn't equal customer satisfaction," VanWingerden says.

Instead, companies need to develop a personal connection with consumers and tailor their experience to meet their needs and preferences. It suggests training customer-service representatives to handle unique needs, such as developing groups experienced in working with new customers or those with specific chronic illnesses.

"Crafting a personal service experience will only become more important in the post-reform marketplace, given an increased focus on 'patient-centeredness' across the health system as a whole," the report states.

VanWingerden suggests companies segment their customer base and develop a customer-experience blueprint for each segment. Payers should look at the entire action lifecycle of how customers become aware of health-insurance products, from the media they consume to the Web sites they visit, to how they use and pay for those products, and what sort of experience they have, to define customers' needs.

"If there are certain aspects of the interaction where basic needs are not met, the customer will complain or switch providers," he says.

Although cost is important, customers are willing to pay more for good service. Accenture's research shows only 6% of respondents were willing to give up levels of customer service in exchange for a lower price, while 44% opposed lowering quality to save money.

Payers that help customers use their benefits can develop loyalty and a personal connection, VanWingerden says. For example, an associate might note if a caller has not used her annual mammogram benefit and offer to help arrange one for her.

Wellpoint's Dan McCoy agrees that customer service is an essential strategy and has worked to organize the company's business, technology, service and information management under one leadership area to more quickly drive change. The company has coached associates to handle calls, avoid transfers and multiple handoffs, and authorized them to resolve issues, he says. Peer-to-peer mentoring helps.

"You have to make sure they understand how their behavior impacts the customer experience," McCoy says.

Wellpoint is studying other industries' best practices to understand service expectations, and asking providers about any complaints they hear from patients.

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