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October 17, 2022

Building modern experience centers for today’s healthcare consumer

Designing consumer-centered experiences enables healthcare organizations to anticipate needs, improve outcomes and compete successfully.

The healthcare customer experience (CX) rarely rises to today’s best-in-class digital standards. Consumers expect to be recognized and receive personalized services and options across any channel, any time. So, patients and members find it frustrating when they reach a customer service agent and have to explain a prior-authorization decision or co-pay calculation.

Consumers aren’t happy: They told us that poor digital service options increasingly influence their decisions to switch health plans. Healthcare organizations aren’t happy either. Many operate large and expensive contact centers that can’t integrate data across the digital channels younger consumers want and the voice channels older consumers prefer. Inadequate service capabilities hurt agent retention, consume IT resources, and reduce member and patient loyalty and engagement. Organizations suffering those consequences are ill-equipped to succeed in today’s hyper-competitive healthcare market.

Even worse: Ineffective engagement can result in poor adherence and health outcomes that increase costs throughout the healthcare ecosystem. That must change. It can. Customer-centered experience centers supported by modern technologies can deliver meaningful interactions that result in healthier outcomes for members, patients and healthcare organizations.

Evolving existing contact centers into experience centers

Transforming a contact center into an experience center is a journey. The optimal CX center will deliver consistent, personalized service that anticipates member and patient needs and expectations. It will authenticate them easily on any channel they choose, with frictionless handoffs between analog and digital touchpoints. While incorporating capabilities such as artificial intelligence (AI) and natural language understanding, the modern experience center is not driven by technology but enabled by it.

This doesn’t mean healthcare organizations need to rip out existing call centers to introduce next-gen capabilities. They do need to assess which components, applications and solutions in their technology landscape require an upgrade, reboot or a cloud switch. The customer experience is an always-changing destination.

The three steps we’ll explain here are key waypoints on the journey to improving healthcare consumer satisfaction and outcomes.

1.    Develop a transformational experience strategy focused on customers first, not what the business currently supports.

Organizations must put the member or patient perspective at the heart of their experience design and strategy, taking an outside-in perspective to define the experience members and patients want and to uncover where existing processes or capabilities fall short. Then the organization can develop a strategy and tactics to address those issues.

The modern CX center has a wealth of tools at its disposal, including conversational AI, intelligent personalized routing and real-time analytics. Implement these only after designing the experience. Badly designed workflows camouflaged with modern technology won’t improve experience scores. For example, a mobile visual interactive response system that mimics a too-complex interactive voice response (IVR) system will still frustrate users.

Strategies also must be flexible. Outcomes-based reimbursement models, interoperability of health records and price transparency all will put new demands on customer relationship management. The experience strategy must evolve, along with the technology selected to support it, to keep pace with changing health consumer needs and expectations and focus on not just improving experiences, but also on reducing costs and helping business metrics.

We worked with a pharmacy benefit management leader in the US with high caller attrition. Virtually every caller had to transfer to an agent because of a non-intuitive experience. Conversational AI—chatbots and voicebots—significantly reduced customer effort, providing the service requested on-the-go using natural language understanding. The bots also improved self-service containment for a wide range of services, including authentication, orders, address changes, refills, prescriptions, billing and case status. That helped reduce voice calls and thus the operations cost. Ultimately, all of this in turn also reduced abandoned calls and interaction handle times, improving customer satisfaction and agent productivity.

2.    Align internally on CX goals and KPIs.

Understanding how members and patients interact with the organization is vital to identifying key performance indicators that reflect and drive improved experiences. It’s important to identify pain points that traditional contact center metrics don’t capture. Statistics about call abandonment, call deflection, average handling time, etc., don’t adequately measure the modern CX. A short call doesn’t always reflect a satisfied consumer. Conversely, a longer call may reflect better engagement and a more meaningful interaction. That’s why member and patient satisfaction scores, sentiment scores and effort scores are today’s most important metrics.

We used these metrics to help a major US health insurance provider whose members were having poor experiences with its IVR system; they were frustrated by long, tedious calls requiring multiple keypad entries that led to seemingly endless loops. Digging into these journeys, we found 70% of the IVR call flows needed to be redesigned to promote seamless channel switches and encourage members to use digital channels such as visual IVR, speech recognition and chat. We redesigned flows based on caller personas to speed things up. Authentication rates improved 18%, and intent recognition rates hit an all-time high of 83%.

It can be a cultural struggle for organizations to adopt these new tools and metrics. CX is an enterprise-wide responsibility, not just that of the customer experience officer. Aligning experience design to modern metrics signals a cultural shift.

3.    Architect a connected technology environment.

Any healthcare organization that offers self-service options to a commercial plan member should provide the same options when they check its Medicare Advantage plans. But lines of business in large healthcare organizations often use different platforms and experiences. A connected technology environment enables CX tools and platforms across all lines of business to use the same data sources and harmonize processes. That helps members and patients receive the same experience across the organization and its brand.

The connected environment captures a comprehensive view of member and patient interactions throughout the organization that enables better data analysis for richer insights. It’s also more efficient to operate, reducing duplicated effort and maintenance costs.

One of our clients, a leading US managed healthcare organization, had been operating more than 15 contact center products and versions. It had thousands of toll-free numbers, a wide variety of call flows—and many frustrated members. We helped the company rationalize and standardize to a unified, updated platform. We eliminated 50% of its unused toll-free numbers and standardized call-routing logic. These steps greatly streamlined member journeys and reduced annual IT operating expenses by $11 million, while first-contact resolution rate improved to 96%.

Next steps

Organizations can start by reviewing their health consumer satisfaction, sentiment and effort scores. If these metrics aren’t monitored, it’s a sign a contact center needs to be modernized.

Positive experiences, whether with bots or humans, drive meaningful emotional connections for members and patients. Organizations that offer effortless, personalized experiences with digital technologies will grow customer loyalty and satisfaction. These will be critical business metrics as the industry continues shifting to outcomes-based reimbursements.

Consumers today have more choice and control over with whom they spend their healthcare dollars, and their satisfaction scores will loom larger in quality ratings, bonus payments and marketing campaigns. In those circumstances, creating the modern experience center is not an optional project; it’s a business imperative.

To learn more, visit the Customer Service Transformation section of our website or contact us.

This article was written by Spencer Osborn, Digital Experience Client Partner, Manikandan Venkatachalam, Head of Digital Business & Technology in Cognizant’s Healthcare services practice and Ashwin Anand, Associate Director, in Cognizant’s Digital Customer Experience practice.

Cognizant Insights Team

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