Health insurers look to digital tools to improve customer experience

Health insurance customers generally report poor experiences with their health plans. Only utility and internet and television service providers have worse customer service scores, and that's saying something. But health insurers say investing in digital tools and other technologies can help them fix this and give their customers a personalized, frictionless healthcare experience.

"The reality out there is the system is complex, and we all own a part of that, whether you're on the payer side or the provider side," said Gregory Brown, a divisional senior vice president at Health Care Service Corp., told an audience at AHIP's Consumer Experience & Digital Health Forum this week. He continued later, "We need to invest in our digital capabilities in a way that will advance simplifying the system and help educate our consumer base out there."

Simplifying the healthcare system and making it easier to navigate is becoming an imperative for health insurers as they face the threat of losing membership to well-funded startups who—instead of redefining complicated terms like "deductible"—are just getting rid of them. It's also becoming more important as healthcare costs continue to squeeze employers and individuals alike.

According to Accenture Managing Director Jean-Pierre Stephan, more than half of a group of 10,000 people enrolled in health insurance coverage in the U.S. failed a healthcare literacy test that Accenture gave them. They didn't know what coinsurance or deductibles were, or the difference between in- and out-of-network coverage. Almost all of those people who failed the test had a high-school degree and more than half had college or graduate degrees.

That lack of knowledge translates to stress and frustration for the plan members and major costs for the U.S. healthcare system, said Jean-Pierre Stephan of Accenture. People who he described as having a low healthcare literacy were seven times more likely to call an insurer's customer service line one to three times per week than a plan member with high healthcare literacy. These customers with low healthcare literacy cost $26 per member per year more than the customers with a better understanding of insurance. That works out to a total cost of $4.8 billion, Stephan said.

Simplifying the healthcare system is easier said than done, but it starts with redesigning a member's experience from scratch.

"If you just automate the experience as it is today, you're just going to get a faster bad process," Brown said. "That's not what we're looking for. Redesign your process with your actual customer in mind first."

But to do that, Brown said more investment in collecting and analyzing data is necessary to understand who the member is and what they need from the healthcare system. Health insurers also need to mend their relationships with healthcare professionals to improve the customer's experience, because the care providers are the ones closest to the patient, Stephan said. The vast majority—87% of providers—don't trust their payers, he said.

Countless mobile apps, digital tools and other technology have been built to improve health and healthcare. But none have significantly improved health outcomes on a large scale, said Dr. Sachin Jain, CEO of CareMore Health System, which is part of insurer Anthem.

"I think there's cause for optimism, but I also think it's important to focus on what we know works, which is relationships with patients."

He cautioned that technology must support the "human to human" interaction—not replace it. One CareMore program aims to improve the lives and healthcare experiences of its loneliest, socially isolated members by connecting them with CareMore employees who work to get them out of the house and physically and socially active. Loneliness is one of the many social factors that contributes to poor health and higher costs.

CareMore built a questionnaire into its clinics' electronic medical record so clinicians can screen their patients for loneliness and refer them to the program. After that, CareMore "togetherness officers" begin calling patients, meeting them where they want, connecting them with community resources for meals or transportation, and building a relationship with them so the patients aren't so alone. So far, 1,000 members are involved in the program and early results show an 11% reduction in acute care costs.

Commonwealth Care Alliance, a not-for-profit organization taking care of 30,000 Massachusetts residents, likewise addresses its members' loneliness with the help of technology. The alliance assesses its patients for loneliness and other social needs and pairs them with a someone who will visit them at home or touch base by phone. Through one pilot program, the alliance also provides patients with a smart speaker that not only reminds patients to take their medicine or visit the doctor, but provides a sort of presence in the room that takes away some of the loneliness, said Dr. Lori Tishler, vice president of medical affairs.

Ashley Snyder, head of growth at Cityblock Health, which delivers integrated social, behavioral and medical care to high-cost, impoverished patients, said about 80% of Cityblock's interactions with its patients are done through secure text messages. Technology is used to predict health risks and facilitate across the care team so care is seamless and integrated, he said.

But Cityblock still puts more emphasis on face-to-face interventions. "It's as simple as knocking on doors. "By going into a member's home or meeting them wherever they may be—under a bridge or in a restaurant—and actually having a conversation with that member about what's important to them, that's how you begin to engage them in a broader care paradigm; and that's how you begin to get the rights, the responsibilities around helping them address their social needs and behavioral health needs. It's not rocket science. It's having the feet on the street to actually go out and engage."