Health Plans' Survival Could Depend on Customer Service

Insurers are facing more pressure than ever to meet customer demands or lose those customers to competitors.

A recent survey of 2,500 health plan members across the U.S. indicated that health plans must quickly tune their offerings and provide service levels that match or exceed members' expectations, says Ray Desrochers, executive vice president of HealthEdge, which conducted the survey.

Consumers expect organizations in their healthcare ecosystem to more effectively communicate with them and supply information and services in a way that is as convenient as their experience in other industries, Desrochers says.

For example, 88% of survey respondents said their health plan could be doing a better job of communicating their total financial responsibility.

Incentives for healthy behaviors including diet and exercise are popular, with 42% of consumers responding they are "very interested" and an additional 45% stating that they are "somewhat interested" in taking advantage of such inducements.

Despite that high level of interest, 48% of those surveyed reported that their health plan offers none of these benefits, Desrochers says.

Only 12% of individuals stated that their health plan provides discounts on gym memberships, although it's possible respondents did not know they have access to that benefit—another result of poor communication.

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Health plans also are missing the opportunity to allow members suffering from chronic conditions to participate in groups, according to the survey. Only 8% of respondents reported participating in a condition-specific support group or other resource resulting from a referral provided by their health plan.

The survey also indicates that members care if their health plans lag in tech-savviness. More than half, 57%, said their confidence in the health plan's ability to provide effective coverage and benefits would be adversely affected by the knowledge that outdated technology is being used.

"Health plans are rated so poorly in comparison to other industries because industries such as retail, travel and banking have had decades of experience ahead of health insurance to better understand, segment and communicate with their consumers," Desrochers says.

"It has only been since the Affordable Care Act that insurance companies have had to deal with consumerism. This is due in part to members' individual buying power via the exchanges and the added financial responsibility that consumers are expected to shoulder with regards to their care."

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Improving communication would benefit insurers' bottom line, Desrochers says. Insurers spend hundreds of millions of dollars and tens of millions of hours each year handling claims-resolution calls, so there is a lot to be gained by improving factors such as a customer service representative's ability to address consumers' concerns, he says.

With the ability to shop for their insurer, type of coverage and where to receive care as they do in other industries, consumers' expectations for the customer experience are now much higher, he says, and insurers must catch up to meet or exceed these expectations.

"All of these findings should serve as a wake-up call for health plans," Desrochers says. "In today's world of short attention spans and fleeting consumer loyalty, a health insurer's competitive position and ability to retain members rests on its ability to quickly provide complete, accurate and up to date information."