Tag: Firstsource

New Wave of Health Insurers Driving Change for Members and Incumbent Plans

Venkatgiri Vandali

By Venkatgiri Vandali, president of healthcare, Firstsource.

A new generation of health insurers has appeared in recent years, gradually gaining momentum in key markets in part by claiming to offer a more modern, digital consumer experience.

The advent of these modern, tech-driven upstarts bodes well for members of plans new and old alike, who are looking for health insurers to finally begin to offer the levels of customer experience, personalization and convenience they have long experienced in other markets like finance and consumer goods.

Consumers clearly want and expect their health insurance provider to offer the same quality of experience they enjoy in other areas of their lives, and plans that can meet that expectation will enjoy a significant competitive advantage.

Companies like Oscar and Clover arguably pose a serious threat to the status quo.  Oscar Health, widely seen as a leader in this new wave of companies, recently topped one million members and has reported north of $6 Billion in revenues for 2021. Clover Health, another new wave exemplar, targeting the lucrative Medicare Advantage (MA) segment, reported a 25% increase in its MA enrollment for this year.

They are growing fast, expanding their coverage areas (Oscar has recently expanded to cover 22 states), and successfully creating the impression that they leverage modern technologies, process automation and business cultures in ways that traditional health insurers have not.

However, the reality is that their customer experience innovations have not been particularly sophisticated, and many of the advantages they claim today – such as adopting mobile first strategies for member engagement — can be replicated by incumbent plans.

In fact, large health plans have been moving quickly to adopt new, digital customer experience technologies and business process automation (BPA), and the small- to mid-sized plans are poised to follow suit. Cultural change will likely be the toughest area for traditional health plans to transform, but technology may have a role to play there as well.

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The Outsized Impact of Digital Engagement On Patient Experience

Noel Felipe

By Noel Felipe, revenue cycle practice leader, Firstsource.

The pandemic has created a sense of urgency around improving patient engagement. Consumers accustomed to Amazon-like retail experiences are now embracing digital across personal transactions, including healthcare. Telehealth and remote monitoring have gained rapid traction, especially for non-emergent conditions and follow-up. At the same time, outpatient visits are rapidly outpacing inpatient. Together, these two trends are resulting in patients spending very little time at hospitals receiving care and paying bills.

With more care delivered through outpatient and virtual settings, healthcare leaders are asking: how do we effectively engage patients to optimize the patient financial experience and enhance recovery?

The answer lies in understanding shifting consumer expectations and designing a patient engagement solution that best fits their evolving needs.

What do modern consumers expect?

As robo calls continue to rise, Americans are using their smartphones to screen calls, making it harder for providers to connect with patients after service. Studies show that the chance of collecting goes down by 58% once patients leave the facility, as they are less motivated to pay once the services have been rendered. This means providers must begin the patient engagement process early in the revenue cycle at the pre-service stage and maintain high levels of engagement during and after service to improve their net revenue.

The good news is consumers increasingly prefer digital channels of communication that offer the flexibility to engage with providers outside traditional business hours and in the privacy of their homes. They also want to get things done quickly and easily. Whether they are shopping for a provider or checking their health insurance coverage, they want to get the information they need, when they need it – and they are willing to use self-service to achieve this.

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