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'Why Can’t My Health Plan CX Be Like My Bank?'

Analysis  |  By Laura Beerman  
   August 03, 2022

AHIP webinar targets the need for payer-specific customer experience platforms and an ROI path where low-hanging fruit precedes clinical targets.

AHIP’s latest webinar—“Get Back to Basics: CX Lessons from Members and Health Plans”—takes its title from surprising data: that the health plan call center is still king for customer experience (CX) and can be a source for wins before targeting more complex clinical objectives.

This from Zipari, the webinar’s sponsor and “the first and only CX platform build exclusively for the health insurance industry” per the company’s website. Payers’ unique challenges were another webinar focus, along with the importance of CX platform decisions that start with strategy to deliver on concrete objectives.

The data cited below originates from health plan and member surveys conducted by Zipari, whose webinar speakers included Maryann Waugh, senior content marketing manager, and Kristin Daniels, director of product. Waugh and Daniels identified the following four components of platform strategy:

1. Start with strategy

“Don’t start looking at apps, portals, and platforms until you have your strategy,” says Daniels.

Her colleague Waugh cites the fundamentals that members are looking for from their health plans—specifically that 42% are looking for more education and support and through various forms of communication.

“A successful CX strategy needs to be aligned with tactics that are based on members’ needs, and knowing how they prefer to communicate,” says Waugh, adding: “This is also the type of information that health plans really need to combine with members’ clinical profiles, to be able to develop an engagement strategy that will work for their particular population.”

While clinical targets were a recurring theme, Waugh and Daniels stress that they may not be the best place to start when it comes to a payer’s CX platform given their next recommendation.

2. Tie everything back to the service center

Zipari data shows that 45% of health plan members still prefer using the call center for help, with Waugh noting: “I've actually been a little surprised at how important the call center has remained to members.”

She adds: “We tend to expect older generations, which is most of Medicare, to prefer the phone. But then we assume that younger generations only want to interact digitally. But we're actually seeing that pretty consistent demand for the call center across all generations and across all health insurance market segments.”

Zipari cited the following data on call center preferences to support:

  • 41% of employer-sponsored plan members prefer to use the call center.
  • 42% of individual commercial members indicated as such.
  • 51% of both Medicaid and Medicare plan members also rely on the call center.

Waugh and Daniels note that call centers can be a source of “quick wins” before more advanced CX ROI targets are met.

“The number of customers who are setting communication preferences or registering for the member portal would be a great simple goal to focus on for a health plan. While the relative value might be lower, members completing that goal will open up additional ROI opportunities,” says Daniels.

She adds that these goals and their data “don't require population segmentation, not even for gender” and that while health plans are collecting this low-hanging fruit, they can be “working behind the scenes on the API or batch connections that are needed to link more of the clinical data sources and behavioral data to the CX platform to enable future goals.”

3. Select a CX platform optimized for health insurance

“Why can’t my health plan CX be like my bank’s?” The webinar answers what members may be asking by citing unique health plan challenges—diverse customers, regulation, legacy tech, and unique healthcare workflows—and then identify management, configuration, analytics enablement, and centralization needed to answer them.

“Tech teams at health plans are always fighting uphill battle,” says Daniels, citing the competition between launching new projects and supporting existing ones—a classic disruptive innovation struggle.

Waugh also cites workforce competition: “There’s always that one person who was the only one who really knew a legacy system or process. And that person will get some amazing job offer across the country, move away, leave the organization, and every project will get months behind.”

4. Focus on measurable goals

“Figuring out what to do first can still be very daunting for a health plan,” says Waugh. “It can also be really easy to conflate strategy with tactics.”

She recommends health plans take a “stepped approach,” with responsibility shifting as goals move from low to high value:

  • Small but quick wins. Communication preferences and member portal registration, targeted by Marketing and Customer Experience teams.
  • Medium value begins to shift to from Marketing to Clinical teams. This category includes paperless communication and PCP selection.
  • Achieving the highest value once the groundwork is laid. New CX platform goals link to Clinical teams in such areas as increased member screenings and chronic care management enrollment.

According to Zipari, the good news is that health plans are seeing a direct connection between their CX platforms and the following “digital wins”:

  • 93% credit their platforms for membership growth.
  • Close to 85% believe CX platforms helped improved their CAHPS and NPS scores.
  • 73% believe member churn decreased due to digital resources.

Waugh notes: “Health plans are dealing with a number of high-impact factors both in the marketplace and within their own organizations. Externally, they're dealing with red-hot competition, pressure for digital adoption and self-service. Many of those demands coming right from consumers themselves, as well as the normal pressures around regulatory compliance and quality concerns.”

Citing internal dynamics such as “structure, history, and budget,” Waugh adds: “And then in the middle is the member who just wants you to make it easy, consistent, and on demand.”

“A successful CX strategy needs to be aligned with tactics that are based on members’ needs, and knowing how they prefer to communicate.”

Laura Beerman is a contributing writer for HealthLeaders.


As platforms become the way healthcare does business, strategy, optimization, and goals are critical for tech decisions that deliver.

Simultaneously, data shows members still rely on the call center, which can lay a critical foundation for customer experience ROI.

Why it matters: Good platform decision-making can deliver on CX goals, ranging from membership growth and retention to customer satisfaction scores.

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