How consumers are creating new imperatives for payers

Five ways to enhance member experience

New challenges in today’s healthcare environment are driving fundamental change in the payer business model and operational processes. Namely, many health plans are struggling to improve the member experience while simultaneously reducing costs.

Member experience challenges include:1

  • 21% annual agent turnover rate
  • 77% of members cite “valuing my time” as most important2
  • Nonpersonalized care plan tools
  • M-F, 9 AM – 5 PM limited call hours and agent availability
  • 75% of health plans view customer care as a competitive differentiator3
  • Disconnected, disparate data sources
  • 1.4 average number of calls to achieve resolution
  • Inability to flag noncompliance
  • $4-6 cost per agent-handled call

As your health plan transitions from a fee-for-service business model to one focused on value-based care, it presents a whole set of opportunities. More than ever, members are part of their own health journeys and not merely bystanders.

These five areas should be taken into consideration when trying to engage consumers:

  1. Improve the member experience at a lower cost
  2. Answer questions consistently for every member, every time
  3. Deflect more calls to lower-cost channels
  4. Leverage enterprise data to create more holistic views of members
  5. Support health outcomes through every member touchpoint


Learn how you can boost member satisfaction

Beyond the healthcare industry, consumers expect fast, accurate and personalized interactions. Why should ours be any different? Your health plan needs to unlock the value of its member data and implement new solutions to set itself up for success. Whether it’s externally facing, such as conversational tools, or internal, like enterprise analytics, there are solutions to keep you on the cutting edge.

  1. Industry Benchmark Report for Contact Centers in the Insurance – Health Industry. Benchmark Portal, LLC. September 12, 2017.
  2. The Business Case for Virtual Agents. Brendan Witcher, Forrester. September 30, 2014, updated January 12, 2015.
  3. Global Contact Centre Benchmarking Report. Dimension Data. 2015.

Learn about Watson Health's solutions for health plans