Payers Missing the Mark on Digital Member Experience, Satisfaction

Payers are falling short in the member experience department, with members reporting dissatisfaction with digital experiences and payers failing to track members’ online encounters, according to a study commissioned by Smart Communications and conducted by Forrester Consulting.

The COVID-19 pandemic accelerated digital transformation by pushing healthcare organizations to accommodate consumer needs in an online format, but payers are lagging behind other industries regarding technology.

The study reflects existing research coupled with survey responses from member decision-makers at US health insurers.

Payers described their digital experiences as basic and transactional compared to other healthcare sectors. Members expressed dissatisfaction with their payer’s website (32 percent), emailing (20 percent), and online chat features (15 percent).

As a result of this dissatisfaction, members were more likely to seek assistance using offline channels, such as phone calls with representatives. However, 51 percent of members who communicated via phone were dissatisfied with their interactions, the study found.

This indicates that payers are not meeting member expectations for digital channels or offline channels. In addition, relying on offline channels, like contact centers, increases costs for payers, the report noted.

Payers may not realize the best route to improve these experiences as many reported not tracking member in-journey and end-of-journey metrics.

During the journey, customer effort scores, the number of times members call about an issue, and customer lifetime value were the most common metrics payers tracked. Customer retention joined customer effort scores and the number of times customers call in the top three tracked metrics at the end of the journey. However, less than 40 percent of payers reported tracking any of these measures.

Payers cannot proactively address member experience due to their lack of knowledge of member journeys. Nearly half of respondents (48 percent) agreed or strongly agreed that they were not tracking metrics enough to understand member emotions as they engage in digital experiences.

This lack of insight also impacts key business metrics, as 48 percent of respondents agreed or strongly agreed that they did not understand how digital experiences in customer journeys influenced revenue, cost to serve, and retention.

Payers’ priorities reflected their intentions to improve member experiences. For example, 60 percent said connecting journey touchpoints to enhance member experience was a member-focused priority. Improving claims processes (62 percent) and relevance and personalization of communication (60 percent) were also top member priorities.

Top business-focused priorities included improving interoperability and data exchange across back-end systems, increasing customer lifetime value, and improving revenue per member.

The study found that payers lacked critical aspects in their approaches to member experience. Only around a quarter of respondents said their member experience approaches included a customer experience vision with clear goals for improving member experience.

Similarly, just 22 percent have a single senior manager in charge of member experience, 25 percent leverage usability tests of member-facing systems before deploying, and 22 percent have data exchange across all systems.

More than half of respondents reported that improving member experience is a challenging feat for payers.

Consistently personalizing member communications, providing members with seamless digital experiences, and prepopulating existing member information on forms were the three most challenging activities for payers.

Although payers expressed their intent to improve member experience, the customer focus areas for the year were researching, selecting, and buying a plan; finding an in-network provider; and researching plan benefits. This indicates that payers are likely more concerned with attracting new members rather than improving experiences for current members, the study suggested.

However, 68 percent of payers are working to improve member communications by consolidating apps and systems, while 65 percent are focusing on centralizing preference management, and 59 percent are working on improving language clarity in communications.

A study from Zipari, a member experience platform, found that payers may see steady benefits and high member satisfaction if they offer consistent digital member experience services across multiple channels.

Additionally, digital offerings such as virtual-first health plans have grown in popularity among plan members.