Delivering a consumer-grade experience in healthcare

Delivering a consumer-grade experience is now the gold standard in healthcare, as it's essential to reducing costs and improving health outcomes.

Why would a consumer need to be on hold for 30 minutes in this day and age to get confirmation of a prescription renewal? Because the renewal team has been inundated with annual renewal faxes, says a customer service representative.

Faxes?

Clearly, the healthcare industry needs to get serious about how it interacts with consumers. Asking someone to wait 30 minutes to get an answer may have been the best the industry could do in the past, but in today’s FAANG-influenced digital era, it’s unacceptable – although still all too common in healthcare.

The consequences go beyond poor customer satisfaction scores. Delays in prescription refills, device delivery and other services can lead to bad health outcomes. Labor-intensive processes are also expensive. The 2020 CAQH index puts the average cost of a manual transaction at almost $7.00 and calculates the industry could save $16.3 billion annually by converting common administrative transactions to digital.

Transcending the tried and true

Calling a product “enterprise grade” once was a selling point: It suggested reliability and scalability. Indeed, enterprise solutions still need these qualities. But unattractive user interfaces and convoluted back-end processes – not to mention the manual workarounds synonymous with many legacy systems – are liabilities. Consumers have become accustomed to better and more beautiful digital experiences in their daily lives. A consumer-grade experience generally has the following qualities:

• Context-aware. Our phones adjust their lighting to the time of day; map and traffic apps route us around accident and construction delays; shopping sites recommend related products based on our browsing history during a session. In the near future, consumers will have smartphone apps that will enable them to enter their symptoms, price parameters and/or health plan coverage into the app, and an artificial intelligence (AI) agent will offer physician recommendations.

• Seamless. The tickets we book at an airline’s website show up in the app on our smartphones, from which we can generate a digital boarding pass to display at the gate. In healthcare consumers will be able to check care provider and service reviews, quality ratings and prices via an app, which will securely store their health ID data, and then set up virtual or clinical appointments with a swipe.

• Elegant. Each interface is beautifully designed; the transaction flow is logical; fields are prepopulated with the data we entered once before. We accomplish these transactions with ease and a sense of confidence all has gone well.

Bringing a consumer-grade experience to healthcare

Health consumers expect their experiences with providers and payers to be as intelligent and empowering as they are in other realms. Here’s where healthcare needs to invest to deliver a consumer-grade experience.

• Digital engineering and modern infrastructure. Meaningful experiences start with a deep understanding of stakeholder needs and wants. The digital engineering process captures these requirements and desires as a core component of the development process. Agile and DevOps methodologies enable faster development, testing and fine-tuning to keep experiences aligned with consumer expectations. Consumer-grade experiences are usually enabled by seamless data flows across applications and systems at scale, powered by a cloud infrastructure. A data orchestration platform normalizes data and makes it available to a wide range of applications. Building on these concepts, we helped one large health plan better serve its government plan members by delivering a core administrative platform as-a-service. Prior to the implementation, the health plan’s manual and outdated systems resulted in long claims processing times and pricing inaccuracies. Its customer service tools were also antiquated. Using our digital engineering process, we helped the organization identify the source of its claims and service issues. Using the as-a-service system, the business was then able to standardize its processes and reduce its claims backlog. The business also automated HIPAA authentication and enabled self-service capabilities, which it says has reduced call volume 15% and shortened call times by 30 seconds.
  
  
• Robotic and intelligent process automation. Intelligent bots can scan and read letters, faxes and email and make simple rules-based decisions to route key data elements to other automated workflows or send exceptions to service representatives. We worked with one of our clients to improve its complex and highly manual eligibility and benefits verification process, which often resulted in patients receiving incorrect information and claims that were denied because of inaccuracies. Using a robotic process automation solution that includes 23 software bots running 22 hours every business day, we helped speed and streamline the process. Among their workflow tasks, the bots pull patient appointment lists from healthcare provider portals, extract appointment details by accessing two different applications and 14 screens, confirm patient eligibility and benefits details, and then route these details to physician practice portals. The result: faster and more accurate verification of benefits and resolved claims.
  
  
• AI and analytics. These tools can help organizations understand consumer behaviors and expectations in real time. For a property and casualty insurer, we developed an analytics platform informed with AI to help service representatives understand customer sentiment while they were on the phone. That helped the representatives anticipate questions, provide better answers and interact with more empathy. We also worked with a claims clearinghouse to help agents bring open issues to full resolution and understand customer sentiment in real-time. The organization implemented a predictive analytics solution that identifies high-risk claims, defines resolution actions, prevents issues from occurring by predicting which customers are likely to be dissatisfied and provides real-time information on customer sentiment so agents can engage with them proactively. As a result, the business claims to have improved customer satisfaction scores by 7%, which is beyond its initial goals.

A consumer-grade experience is now the gold standard in healthcare, and achieving it is essential to reducing costs, improving health outcomes and thriving in an increasingly consumer-driven industry.