Becoming a Digital Payer: Advancing Customer Service

HealthEdge has identified five key attributes that drive digital payers, enabling them to rise above the competition and lead the way to better outcomes across the entire healthcare delivery system.

Digital Health Payers focus on:

  1. Improving end-user and member centricity
  2. Achieving higher levels of quality
  3. Increasing transparency
  4. Advancing customer service
  5. Reducing transaction costs

Over the next few weeks, we will dive deeper into each attribute, delivering resources, information, and insights to enable health plans to transform into digital health payers. As we continue the conversation around what it means to be a digital payer, this discussion focuses on advancing customer service.

Ever-Increasing Customer Service Levels

In a service-oriented economy, the organizations that deliver the best service typically win – and healthcare is no different. Health plans that are not able to optimize customer service are not only frustrating their members and providers, but they are also missing out on significant efficiency gains and cost savings.

The recent study, The State of the Healthcare Consumer, conducted by Porter Research, found that 25% of respondents required two or more calls to achieve a resolution when contacting their health plan for support. The study also indicated that health plans waste more than $654.5M per year in unnecessary claims resolution calls.

Digital payers focus on resolving these challenges by leveraging technology to deliver consistent, high-quality customer service. By using next-generation, digital solutions, health plans can better equip customer service teams to support inquiries, automate processes to speed service, and advance personalization.

Support Inquiries from Members, Providers, and Other Stakeholders

Digital payers empower customer service teams with access to real-time, accurate information to support inquiries from members, providers, and other stakeholders. Providing immediate answers to those seeking benefits information, cost estimates, and claims status improves member engagement, satisfaction, and financial clarity. Payers that embrace digital transformation use next-generation tools and connectivity to ensure customer service teams have the information they need when they need it.

Automating Processes to Expedite Service

Reducing costs and improving operational efficiencies are today’s top priorities, accounting to the 2022 Annual Health Insurance Market Report of more than 300 health plan executives [link to exec survey summary].

To help manage costs and identify new efficiencies, digital payers turn to modern technology to automate repetitive business processes that can improve customer service. By making critical information more readily available to support inquiries and self-service activities, customer service representatives are able to focus their time on more complex inquires requiring high-touch, one-on-one engagement. In addition, customer service representatives can respond faster and with more accurate information to member inquiries.

Advancing Personalization

Consumer have grown to expect a personalized experience because of their regular interactions with retailers and digital giants. Digital payers have the data, information, and tools to deliver a personalized experience from their members. With next-generation solutions, digital payers have greater access to more real-time member data that allows them to personalize their communications with members, further improving member satisfaction and loyalty.

Increasing Service Levels as a Digital Payer

HealthEdge provides the digital foundation to enable digital payers to improve processes for handling member inquiries, automate and speed workflows, as well as add the personalization that today’s healthcare consumer has come to expect. Next-generation solutions from HealthEdge deliver a connective transformation that improves the flow of accurate, up-to-date information. As a result, digital payers can use that information to align communications, improve access to data, and continually elevate levels of service.

To learn more about how your health plan can leverage modern solutions from HealthEdge to improve customer service and become a digital payer, visit www.healthedge.com or email [email protected]

Becoming a Digital Payer: Enabling Business Transparency

HealthEdge has identified five key attributes that drive digital payers, enabling them to rise above the competition and lead the way to better outcomes across the entire healthcare delivery system.

Digital health payers focus on:

  1. Improving end-user and member centricity
  2. Achieving higher levels of quality
  3. Increasing transparency
  4. Advancing customer service
  5. Reducing transaction costs

In this five-part blog post series, we are diving deeper into each attribute, delivering resources, information, and insights to enable health plans to transform into digital health payers. As we continue the conversation around what it means to be a digital payer, this discussion focuses on embracing business transparency.

Embracing Business Transparency

Transparency is increasingly becoming a hot topic for health plans. Consumers are demanding more transparency in terms of benefits, costs, and care choices. Government mandates like the Transparency in Coverage Rule and the No Surprises Act are requiring payers to make more data available to more healthcare stakeholders. Everyone across the healthcare ecosystem including members, providers, and other partners need greater access to data as they attempt to improve health outcomes and financial decision making.

Digital health payers are embracing this new emphasis on transparency that is possible with modern claims processing, care management, payment, and member engagement technologies like those from HealthEdge. They are able to use their next-generation systems and automated processes to support better integration, break down silos across departments, and optimize the flow of information.

Consumer Demand for Transparency

Today’s more tech-savvy consumers have grown accustomed to having information at their fingertips. Digital giants like Amazon and Google make price and quality transparency simple for just about any product or service – delivering ease of comparison across multiple retailers and products.

However, consumers remain in the dark when it comes to cost and quality information to support their healthcare decisions. Patients visit doctors, schedule surgeries, or visit urgent cares with limited-to-no visibility into quality or costs to inform decisions and plan ahead.

According to McKinsey & Company, more than 60% of patients report they want more information when deciding where to get care. Digital payers are leading the way to meet this consumer demand for greater transparency by making plan pricing and information more accessible. Through member portals, digital tools, and integration with other systems requiring information for consumers, digital payers can help the healthcare industry make a giant leap forward when it comes to increasing transparency.

Transparency across the Healthcare Ecosystem

Access to real-time health data and benefits information can improve care decisions for providers, members, and other partners. Better cost and pricing transparency can also enable providers and patients to make better financial decisions. Health plans have an opportunity to lead the way in this transparency effort by improving the exchange of information across the healthcare ecosystem.

Digital payers make data more accessible to internal team members, including care mangers, customer services teams, and external stakeholders such as providers and caregivers, through fully integrated systems that optimize the flow of information. With the right information available across the ecosystem, healthcare organizations can improve care and financial outcomes for all.

Regulation-Driven Transparency

Transparency does not just benefit health plans, members, and providers. New rules require more transparency from health plans and enforce penalties for those who do not comply. According to CMS.gov, as of July 1, 2022, group health plans and issuers of group or individual health insurance are to begin posting pricing information for covered items and services. More requirements will go into effect starting on January 1, 2023 and January 1, 2024 as part of the Transparency in Coverage rule.2

In addition, the No Surprises Act implemented on January 1, 2022 is also driving the need for greater transparency and information sharing as health plans are now required to cover some out-of-network claims and apply in-network cost-sharing if their provider directories are not kept up to date, according to Kaiser Family Foundation.

To maintain compliance, digital payers are using modern technology that can support the flexibility and digital connectivity necessary to seamlessly exchange data with those needing access. Whether is it care managers needing faster access to benefit utilization numbers or prior authorizations, or members needing insight into care networks, digital payers are able to provide transparency across the ecosystem.

Enabling Transparency with HealthEdge

HealthEdge delivers next-generation solutions for health plans to transform transparency requirements into business advantages. With best-in-class solutions that seamlessly integrate and share data across the ecosystem, HealthEdge technology delivers the digital foundation that enables digital payers to use and exchange critical data in a way that is meaningful for members, providers, and other partners. Solutions including, HealthRules® Payor and GuidingCare® leverage the power of true integration capabilities to streamline data flow across all lines of business and functional departments as well as third-party systems. With HealthEdge, payers transform into digital payers, leading the way in delivering transparency in healthcare.

Learn more about how to become a digital payer and turn transparency into your business advantage by by visiting www.healthedge.com or emailing [email protected].

1 McKinsey & Company. Consumer decision making in healthcare: The role of information transparency. July 13, 2020

2 Centers for Medicare & Medicaid Services. Transparency in Coverage

3 Kaiser Family Foundation. No Surprises Act Implementation: What to Expect in 2022. December 21, 2021

Becoming a Digital Payer: Constantly Striving for Higher Quality

HealthEdge has identified five key attributes that drive digital payers, enabling them to rise above the competition and lead the way to better outcomes across the entire healthcare delivery system.

Digital Health Payers focus on:

  1. Improving end-user and member centricity
  2. Achieving higher levels of quality
  3. Increasing transparency
  4. Advancing customer service
  5. Reducing transaction costs

In this five-part blog post series, we’re diving deeper into each attribute, delivering resources, information, and insights to enable health plans to transform into digital health payers. As we continue the conversation around what it means to be a digital payer, this discussion focuses on ever-increasing quality.

Achieving Higher Levels of Quality

While high quality care and service is top of mind for all health insurance payers, digital payers constantly strive to improve quality and do so by leveraging modern, digital platforms. For these organizations, quality is a mind-set in which every aspect of the business focuses on improving.

As traditional payers transform into digital payers, there are three key areas in which the organization should focus on improving quality that will deliver the greatest impact on the entire healthcare delivery system – communication, data, and care.

Improving Quality in Communications

Today, communication occurs through a variety of channels including portals, phone, email, telehealth, and face-to-face conversation. Without a single view of these communications, key stakeholders can easily be left in the dark, resulting in less accurate claims and reimbursements and jeopardizing optimal health outcomes for members.

To improve quality in communication, digital payers can:

  • Provide access to accurate, real-time information to those who need it
  • Consolidate or integration communication channels to reduce the number of touch points
  • Make real-time data more accessible to care managers and customer service team members facilitating communication between stakeholders
  • Leverage true integration between digital health solutions across the entire health delivery system.

The CMS National Quality Strategy includes a goal of the program to Embrace the digital age, explaining that quality can increase when organizations, “Ensure timely, secure, seamless communication and care coordination between providers, plans, payers, community organizations, and patients through interoperable, shared, and standardized digital data across the care continuum to achieve desired outcomes and provide patients direct access to their information. 

In addition to HealthEdge’s inherent capability to share real-time data across lines of business, functional departments, and third-party systems, Wellframe (HealthEdge’s digital member engagement platform) takes collaboration one step further by facilitating real-time communication and insights between care managers, customer service representatives, and members.

Improving Data Quality

Digital payers strive for excellence in making high-quality, accurate data more accessible. The result? More accurate, trustworthy data is available for better contract negotiations, more automated claims processing, and smarter business decisions.

Accurate data also improves claims accuracy, saving time and cutting costs due to less rework and fewer under/over payments. Digital health payers use technology and innovation to improve data quality through:

  • Establishing a central source of truth and data standards to create and maintain quality data
  • Integrating disparate systems to improve access to accurate data
  • Leveraging automation to improve accuracy and eliminate manual steps in which data discrepancies could be introduced
  • Implementing innovative tools to extract, use, and share valuable data across the care continuum.

Improving Care Quality

Health plans have an opportunity to positively impact care quality as a digital payer. Digital payers use technology and information to constantly improve quality of care for their members by streamlining processes, improving care coordination, and enabling better care decisions.

Digital Payers can improve care quality by:

  • Connecting with members in meaningful ways, delivering information and guidance at the right time
  • Improving care decisions by enabling greater access to valuable health and benefit information to care managers and providers when they need it
  • Facilitating better care coordination between members, providers, caregivers, and members
  • Leveraging technology to improve member engagement through mobile-friendly applications and portals.

As digital payers strive for ever-increasing quality across their organizations, they enjoy the added benefits of more informed provider networks, lower operating costs, higher efficiencies, and better outcomes for their members.

Learn more about how HealthEdge can help your health plan improve quality through digital transformation at www.healthedge.com or [email protected].