Charting a better user experience with health insurance -
Old infrastructure and new challenges complicate the customer journey

The nature of customer experience management has changed dramatically for health insurance companies in the past few years, driven by the evolving composition of the customer base and a new focus on value-based care. However, many companies have found themselves unprepared for the transition. Legacy systems and a mindset based on interactions with corporate HR departments have impeded progress, resulting in a customer experience that most observers say lags far behind those in the banking and retail industries.

In fact, the current situation is not encouraging. “Customer satisfaction ranks down near utilities, airlines and the postal service,” says David Schultz, founder and president of Media Logic, which provides strategic marketing services to the healthcare and financial industries. “Part of the problem is that the infrastructure was not designed for today’s customers.”

The previous model was built to serve employer groups that provided their employees with insurance coverage. But when the public exchanges were launched in 2014 under the Affordable Care Act (ACA), two major changes occurred. Millions of people started buying insurance directly. And most people—including those covered through their employers—began to see a significant rise in out-of-pocket costs mostly due to ever-increasing deductibles.

Both of those factors drove consumers to adopt more of a retail mindset around their healthcare purchases, which in turn changed their expectations of what an insurance company needed to do to provide a positive customer experience. “Unfortunately, neither the IT side nor the human side of the insurance companies was ready to meet the needs of this new healthcare consumer,” Schultz says.

Assessing the experience can be difficult because customers and health insurance companies do not evaluate the customer experience in the same way. “Customers do not think about how many rings it took for the rep to pick up, or even about how long the issue took to resolve,” says Jenny Cordina, partner at McKinsey. “For them, it’s the journey as a whole that counts.” When one touchpoint is optimized, it may well improve, but if another is still highly unsatisfactory, the whole experience gets hurt.

Mapping the customer journey

Healthcare is complex, from both a medical and an administrative viewpoint, which is a key reason why it has not kept up with other industries. It entails a large collection of disparate information—everything from financial data to X-rays and electronic health records (EHRs). Pulling all that together into a meaningful picture is both a conceptual and a technical challenge.

An important part of delivering a better customer experience is to map the customer journey. “In healthcare, the customer goes through seven major steps,” Cordina explains. “The process begins with finding and signing up for a plan and moves through finding a provider, receiving care, managing finances, resolving issues and then renewing.” Integration across each of the different touchpoints is an issue. “Because different touchpoints are not housed in the same place,” Cordina says, “it can be difficult to get all the parts to work together.”

Consumers must often move from one application to another to complete the journey. For example, point solutions have sprung up to help consumers select their healthcare plans. A search for “find health insurance” typically brings up an array of sites where consumers can compare plans and look for one that matches their needs, but a plethora of options come up. The same is true for searches for supplements to Medicare; a confusing set of options appears, including the relatively new Advantage plans that roll all benefits into one HMO-like plan. Those can get the process off to a rocky start.

Once enrolled, the customer is still not out of the woods. “The benefits structure is confusing,” says Cordina. “People get frustrated trying to figure it out. Many different types of provider networks are covered on one site, and systems are often not built to make it easier for the consumer to understand.” One area in which improvements have been made to the customer experience is in providing patients with access to their medical records; many providers now have portals where lab results are posted quickly. But they might have to leave the site to get reviews of providers.

Consumers can also use tools to help select providers and services. “Some software can help patients pick out the best provider based on price and ratings,” says Schultz. “They might find that the state-of-the-art facility charges $600 versus $2,100 for the local hospital. It’s unpredictable. In the past, people did not ask about the price because they were paying a relatively small co-pay. When the first dollar you pay is toward the deductible, followed by co-insurance on each dollar after that, you start looking much more closely at price.”

Metrics for healthcare quality are also hard to come by. “Unlike some industries, healthcare does not have clear standards for quality,” Schultz says. “This makes it difficult to assess value, which is derived from the combination of price plus quality.” In the absence of an unquestionable success or clear failure of a medical treatment, consumers are not even able to assess the quality of care.

End-to-end orchestration

TriZetto, acquired by Cognizant in 2014, was historically in the payer space, offering a platform for claims administration and a claims clearinghouse for eligibility. With a client base that included the majority of the “blues” and nearly half the provider-owned plans, the company had a firm place in the healthcare insurance market. Its acquisition by Cognizant presented a clear path forward into a digital, consumer-oriented strategy. “The launch of TranZform provided an environment for the consumerization of healthcare,” says Joel Gleason, senior VP of health systems strategy and TranZform sales. “It recognized the fact that consumers of healthcare need and want more of a retail experience, the way they do with other transactions.”

TranZform was built in a modular mode so that companies could add capabilities according to their priorities. One piece in place is the comparison shopping module. “Users can see what is available in their geographic area, find out the cost and compare different plans,” says Gleason. That component is most often used by third parties such as brokers who are selling policies. The product is branded for that company. Another module is designed to set up a profile for the customer. It allows users to select channels for communication and times when they can be reached. Both of those products can be added to an existing portal or used as standalone applications.