Success for health plans and risk-bearing entities in the post-pandemic world requires making the member experience a central aspect of their offerings. Those that achieve high ratings attract more members and higher retention rates. Optimizing their access to care reduces unnecessary healthcare services as patients get treatment before health concerns become emergencies.
Many payers find improving their member experience challenging because it requires rethinking antiquated systems and streamlining processes to serve members better. Here are some ways that health plans and risk-bearing entities can start to prioritize the patient experience and improve member access to care.
The member experience is more important than ever, as ratings and surveys help members and other stakeholders find the right health plan for them. For example, the Centers for Medicare and Medicaid Services’ (CMS) Star Ratings are one way plans are held accountable. The ratings help patients compare Medicare Advantage and Medicare Part D plans by ranking them. Of the many attributes critical in this ranking system, the customer experience metric is proving challenging for payers to improve. CMS is hinting that they will likely emphasize the metric in the future.
CMS is not alone in its emphasis on the member experience. Healthcare.gov has a rating system that includes member experience. Also, the Consumer Assessment of Health Plans Survey (CAHPS) helps member evaluate their experience receiving care.
In the modern age of healthcare, the member experience is central to long-term success and competitiveness. Health plans and risk-bearing entities that don’t make it a priority will find it increasingly difficult to find and retain members.
Payers’ main challenge when improving the member experience is the outdated workflows and processes that impede care. However, they can take proactive steps to ensure that members have the tools and knowledge they need to navigate the healthcare system:
Prior authorizations are often a pain point for members and providers. The manual processes for authorizations can delay care for weeks. It impacts patient health and how they view their health plan and payer.
AI-assisted processes allow payers to improve their efficiency and eliminate antiquated programs for prior authorization. Automation helps payers with prior authorization workflows, ensuring a faster process and patient care. It results in timely care and a better member experience.
Payers need to approach member engagement like a consumer company to improve the member experience. Consumer companies enhance member contact information and leverage multiple channels of contact. Likewise, health plans and risk-bearing entities need to consider an “engagement first” approach to patient care.
Many health plans rely on only one outreach method and fail to ensure that member contact information is up-to-date and correct. Payers need to verify that member contact information is accurate to ensure that they reach members successfully. However, members have come to expect a variety of channels for communication.
Digital communication is considered a given in today’s world. Members want to set up appointments online and have automated reminders easily. In fact, one survey found that 80% of healthcare consumers prefer digital channels, such as online messaging, texting, or virtual appointments, when communicating with their providers.
It stands to reason that they would also like digital communication from their health plans. Scheduling and digital intake technology will improve the member experience and optimize care access.
The healthcare system is challenging for even experts to navigate. Members often find understanding health plan premiums, finding in-network providers, and analyzing their costs confusing and complex. Yet, patient health insurance literacy is critical for their overall health.
A 2021 systematic review found that health insurance literacy, including primary care and preventative services, was essential in health care usage. It’s no surprise, then, that low healthcare literacy results in billions of dollars in care that would otherwise be unnecessary.
Giving members the information they need and improving healthcare literacy gives them the resources to navigate their healthcare journey. It also increases their experience and ensures members access care when needed.
While digital communication continues to grow, members still need to have someone to call to help them navigate the healthcare system. And for many, making a phone call is the first step in their engagement with healthcare plans and risk-bearing entities.
Access to a representative when needed is critical to ensure members have answers to their pressing questions and someone to provide them with direction for care. The right representatives will help improve health insurance literacy, patient communication and enhance the overall member experience. Call centers smooth the patient journey from the first call to reimbursement and increased access to care.
Because of the nuance of healthcare and compliance regulations that come with it, healthcare payers and risk-bearing entities cannot use the average call center. Instead, they need representatives that specialize in healthcare. These representatives must understand payer procedures and comply with state and federal regulations.
The right call center is vital for healthcare plans to answer calls quickly, get first-call resolution, and decrease call abandonment rates. First-call resolution improves the member experience and ensures they have ample access to care. A state-of-the-art call center like the GeBBS Healthcare Solutions call center that handles healthcare inquiries only and has the latest infrastructure in place to handle high-volume traffic (up to 300K calls a month) is important for helping members schedule preventative visits and chronic care management.
The long-term success of health plans and risk-bearing entities requires improving the member experience and access to care. Members have more of a voice than ever, as they can easily rate their experience and influence potential members. To remain competitive, payers must ensure that they provide patients with the necessary resources, streamline their workflows for faster care, and improve the communication experience.
Automation and outsourcing to a third party are two critical ways that payers can improve their member experience. Adopting tools to streamline prior authorizations and making it easy for members to contact a knowledgeable representative will help improve the care journey. It will make it easier for payers to retain members and attract more members in the future.
Here at GeBBS Healthcare Solutions, we take the patient’s experience seriously. We help organizations provide a seamless and simplified patient experience that benefits patients and businesses. Our technology and workforce management emphasizes a patient-focused approach with end-to-end services.
GeBBS is proud to be recognized as a Leader by Everest Group’s Revenue Cycle Management Operations, one of Black Book Market Research’s Top 20 RCM Outstanding Services, one of Inc. 5000’s Fastest-Growing Private Companies in the United States, one of Market Research’s Top 20 RCM Outstanding Services and one of Modern Healthcare’s Top 10 Largest Revenue Cycle Management Firms.