Crushing Demand Presents Opportunity to Rewire Member Experience

Crushing volume and call surges have overwhelmed both health-plan exchanges and customer-service channels of major payers. With 5+ million new members signed up by March 31, call volume was 10x more than pre-ACA levels.

Many callers who were first-time members had a range of questions; existing members with policies that didn’t meet federal standards were confused about choosing a new policy. Response delays left many consumers fuming. In this Point of View, we show how payers can manage the unprecedented wave of customer response coming their way.

Post-Mortem for Last Enrollment Cycle

The first order of business is to conduct a post-mortem for the recent enrollment period. Review trends and shifts in key operational metrics, such as average handle times, wait times, and first call resolution; and demand data, such as call volume, patterns, and types. Examining internal and external benchmarks and mining operational data can spotlight operations that need the most attention. That data should inform payers’ deployment of new operational measures, demand forecasting, and management capabilities. See below for an example of call center benchmarking:

1Why focus on this now?

This is the time – between enrollment periods, even while handling fallout from the last enrollment – to transform your member experience. Now that consumers are more engaged in and responsible for choosing health plans, their overall experience and the role of service will be increasingly important. In addition, state and federal exchanges are likely to provide quality ratings for health plans, so customer service could well be a factor in member sign-ups.
2What changes should payers be considering?

Leading payers will use the challenge of crushing demand as an opportunity to rewire operations to deliver a differentiated experience based on a clear understanding of consumer needs. Payers will want to develop more flexible and scalable models to handle uncertain demands in capacity and may want to contract with external providers. All will need to optimize operations by looking at where cross-training, skill building, and reassignments could benefit consumers.
3What's the best approach to defining a next-generation consumer experience?

To build a future customer-service vision, payers need to understand what consumers really want by segment and channel. They've got to identify consumer needs and the value propositions specific to those consumers. Then select the operations and technology best designed to provide the signature moments that make the experience palpable for consumers. Ideally, you can focus on value propositions that are most consistent with your brand and mission.