Three Digitized Ways To Improve the Member Experience

By Abhishek Danturti Sharma, assistant general manager and lead data scientist for business transformation, HGS.

Abhishek Danturti Sharma

Health plans are all too familiar with the challenges of member experience—that perfect storm of call/processing volume surge, staffing challenges, and critical moment-of-truth engagement pressures. According to JD Power research, the stakes are even higher for 2021.

The organization’s fourth annual study found that member satisfaction averages dropped from 712 on a 1,000-point scale in 2009 to 701 in 2020. J.D. Power and Associates measures health plan satisfaction of 133 health plans in 17 U.S. regions in seven areas: coverage and benefits, provider choice, information and communication, claims processing, statements, customer service, and approval process.

To be successful, today’s digital-led member engagement must meet the needs of Generation “C” – the “connected” customer demographic that spans generations. These consumers make purchasing decisions based on brand reputation and a more personalized experience. A strong digital toolkit, containing interaction analytics; AI-powered data capture; and automation, will elevate and customize engagement to earn and retain these buyers. It may be counterintuitive, but digital enablers such as analytics, AI-powered intake, and bots can deliver a more empathetic, customized member enrollment experience—one that earns and retains customers for life.

Utilize Interaction Analytics

Interaction Analytics solutions offer key advantages along all consumer journey touchpoints, delivering essential ROI with voice of consumer insights related to preferences and experience enhancements to drive higher CSAT and NPS. Contact centers have a goldmine of customer feedback. Insights can be built from speech data that is a valuable information source of customer sentiment and intent. The data tells the unbiased story here – to avoid missed opportunities or misalignment of feedback. The proactive insights built at the crucial open enrollment phase are actionable by helping health plans to tailor their product development to consumer choice across key member demographics.

Apply AI-powered data capture

Today’s cutting-edge machine learning, optical character recognition (OCR), and intelligent character recognition (ICR) for cognitive intake have elevated the document management process once considered highly burdensome for payers. The open enrollment process is a touchpoint ideally suited to intelligent data capture. Open enrollment is a highly paper-intensive process that presents an excellent opportunity for improvement. With the inherent paperwork and processing, AI-powered innovation provides tremendous opportunity for workflow enhancements to minimize subjectivity of structured/unstructured data—for faster turnaround and cost savings.

Incorporate Automation

By bringing greater automation to the open enrollment process, organizations can decrease their labor requirements while realizing a greater return on investment. Bots can streamline the repetitive and time-consuming steps of the open enrollment process for crucial desktop efficiencies that significantly impact customer experience. This “straight-through processing” is the smartest path of least resistance, with a bot-brain approach to address seasonal challenges with intelligence.

BPO partners bring a unique solution mix to address open enrollment: automation and analytics as-a-service capabilities, seasonal talent scale and agility, and right-shoring cost savings. The right BPOs are ideally suited to accommodate needs like open enrollment on the principles of lean operations, and also co-creation, design thinking, and globalization. Beyond cost-cutting, good BPOs implement meaningful changes that help eliminate silos and align objectives in order to achieve true operational and engagement impact.


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