Can your tech do this? How to enhance your health plan members’ digital experience.

Can your tech do this? How to enhance your health plan members’ digital experience.

Health plans are shifting focus to ensure member satisfaction. Here’s how technology — even internal solutions — affect the digital experience of your health plan’s members.

Do you ever think about how different banking is now compared to 10, 20, 30 years ago? First came ATMs. Then debit cards. Then online banking. Today, if you step foot inside a bank, unless it’s for a high-trust/high-value conversation where only face-to-face will do, it’s a huge inconvenience. The world is filled with advanced technology and today’s consumers don’t care why healthcare lags behind. If the member experience you provide isn’t the seamless digital interaction they have come to expect, the next time they have a choice, will they choose you?

Health plans should focus now more than ever on the digital experience of their members to ensure satisfaction. Much like finance, the healthcare industry is becoming increasingly digital. Adding to that, many of your members are shouldering more healthcare costs than ever, which has them seeking clarity at the most granular levels. In a culture of choices, your health plan members are discerning clientele. 

Patients are Consumers

“Patients are increasingly becoming consumers because they have an increasing responsibility for the cost of their care,” writes Jonah Comstock. Statistically, you likely already know that member satisfaction is important because most of you are focusing on it. But what we can tell you is that regardless of a focus on digital experience, the big pillars of member satisfaction have not changed: service and value. 

Without nailing these basics, all the digital strategy in the world won’t help. Health plans are facing major shifts based on the consumer-focused mindset of the times. In short, your health plan member has choices now (and even those in group plans are being given more options by employers). 

Research shows that 42% of seniors prefer to shop for healthcare coverage online.

(source)

Basic customer service capabilities are part of the member-first focus shift at health plans. With the right focus on the tenets of member service, digital capabilities can augment them. When health plan members look for a good digital experience, that often means convenience, transparency and personalized communication. With the right technology, you can more easily satisfy these health plan member needs. 

Digital Experience Correlates to Member Satisfaction

While health plans have been citing an increased focus on the member experience, remember that doesn’t only mean the digital front door (e.g., health plan-to-member customer service-focused apps and portals). In a recent survey, 80% of Americans asked said they utilize online health information. 64% say they reference online provider reviews, and a quarter say they now use mobile tracking tools. 

The study’s author concludes, “Patient engagement in decision-making [is] associated with increased patient satisfaction and improved health outcomes.” For health plans, focusing on the digital experience of members is directly correlated with satisfaction. Create an experience that is highly engaging, and your member NPS is likely to be high (read more on measuring net promoter score [NPS] here).

While the correlation between an engaging digital experience and member satisfaction is clear, a new Forrester analysis says that only about half of health plan enrollees feel that their interactions with insurers are helpful. The analysis concludes, “Health insurers should take this into consideration when evaluating and adopting new digital customer service technologies like chatbots or real-time conversational guidance and analytics tools.”

What’s next? 

Any of your health plan’s internal processes and relationships with other stakeholders like providers and third-party service providers that could impact members are ripe for innovation. That level of comprehensive communication — with third-party suppliers, providers, and members — is exactly what ClarisHealth’s technology platform Pareo®is designed to offer. 

Talk to ClarisHealth about how Pareo advanced payment integrity technology is helping health plans successfully implement their digital-first strategies. 

4 Elements of Payment Integrity that Affect Provider NPS

4 Elements of Payment Integrity that Affect Provider NPS

Here’s how payment integrity affects the net provider score (NPS) with providers in your network. Two elements essential to health plan operations all too often find themselves at odds:
  1. Health plans put payment integrity processes in place to ensure they are paying claims appropriately.
  2. Health plans rely upon the satisfaction of their network of healthcare providers as key to their services’ value to their members.
What if your health plan’s payment integrity processes could augment the payer-provider relationship rather than damage it? Every interaction with your providers is an opportunity to build that relationship – if you have the proper tools in place to support mutual goals and transparent communication.  

“The Net Promoter Score (NPS) — a 14-year old metric that’s traditionally managed by insights and marketing departments – is driving growth and direction at a healthcare company that occupies sixth spot on the Fortune 500, has an operating income of $13 billion, and boasts 260,000 staff.” –WARC, October 2017

  These 4 key elements of Payment Integrity affect provider net promoter scores: 1. False Positive Rates A concept either generated internally or by a third-party can create an overpayment false positive, meaning the health plan “thinks” it’s an overpayment when it actually isn’t. False positive rates have the potential to cause great harm to your health plan’s NPS score, as it may create damage that is more difficult to correct than to prevent. Without good data, insight into this problem is minimal and extremely siloed. While many providers may feel it easier to pay for what an insurance company has determined to be an overpayment, there are some legal cases where health plan error has caused overpayments to be mistakenly claimed. These “clawbacks” are sure to leave a negative mark on provider’s perception of your health plan if they feel the claims to be erroneous. Pareo®’s concept management capabilities give plans all of the needed documentation, descriptions and rules, including sample claims, to prevent false positives before approving a new concept. While it sounds simple, the ability to combine all necessary information into a singular interface that health payers can access and make decisions from is a unique benefit.
2. Medical Record Request The old, manual way of requesting medical records is a big burden on providers and fraught with potential minefields. Notably, payers can reopen cases on “good cause”, instances which are often attributed to ignoring medical record requests. If a provider is deemed as an outlier, they can be a target for medical requests that may seem (to them) redundant. That’s because insight to the information behind the request is limited. Pareo® workflows minimize duplicate requests, enable quick and secure sending/sharing, and supports request detail to allow for HIPAA-compliant information to be exchanged. The discreet and accurate advantage that Pareo® gives to the medical record requests is more straightforward than manual systems. With everything at their fingertips and compliance with requests made much easier, resolving the outdated processes of medical record requests is an easy way to boost provider NPS. 3. Full Claim Denials Many times, a health plan will deny an entire claim when only a line item or two are incorrect because their systems are inflexible. The inability for said systems to be dynamic and responsive is a big detractor when it comes to provider NPS. For one thing, denials are very costly to providers. The process is hardly straightforward and despite both providers and payers being frustrated by denied claims, it is the provider who is at risk for not getting paid. This alone can create undue stress and added tension, which may boil over at technology inefficiencies. Health plans and payers are entering into a more symbiotic relationship, and more can be done to improve the workflow of claims denials.  

“A study by the Medical Group Management Association found the cost to rework a denied claim is approximately $25, and more than 50 percent of denied claims are never reworked.” AAFP.Org

  Pareo® gives health plans the capability to deny claims at the claim line level to avoid the costly back-and-forth with providers. Part of a broader value involving analytics and ROI, our technology solution streamlines the claims process to reduce costs and improve efficiencies. By addressing claims denials at a granular level, a provider can more accurately correct information where needed. 4. Provider Outreach No more vague letters and the same type of denial over and over again. Pareo® supports provider education and detailed explanations for transparent communication and real-time feedback. This can help the provider-payer relationship, which often breaks down over poor communication. Specifically, Pareo® provides a “log” of communications between providers and payers that can prove vital in clearing up issues. Pareo®’s portal easily combines claims, supporting medical records requests, and other necessary information along with communications records securely so that health plans can more effectively manage their provider relationships. Data Visibility Makes the Difference In April, United Healthcare shared the news that their NPS score reached an all-time high in 2017. This is due to aligning priorities with customer feedback, says UHC, and in 2018  the health insurer is giving enrollees the ability to make strategic decisions based on data – at customer demand. In fact, UHC has focused on several top priorities this year that center around the ability to clearly see and utilize data – at the consumer and provider stages.

Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.

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Are Your Plan’s Healthcare Providers Happy? Tips on Boosting Your Net Promoter Score

Are Your Plan’s Healthcare Providers Happy? Tips on Boosting Your Net Promoter Score

Keeping your health plan’s providers happy will also keep your members satisfied. Here’s how technology can support your net promoter score with providers. “How likely are you to recommend this health insurer to your business associates?” Do you know how the healthcare providers in your network would answer this question about your health plan? On a simple 1-10 answer scale, this question aims to understand how successful your health plan is with experience, satisfaction and most importantly, loyalty. Across many industries, this metric is commonly called a Net Promoter Score.  

Net Promoter Score (NPS): A way of measuring customer satisfaction based on how likely consumers are to recommend your company to others.

  While your health plan may be familiar with the “Net Promoter Score” metric as it pertains to members, don’t forget that your health plan also serves healthcare providers’ needs as well. And their experiences interacting with your health plan’s processes can directly impact your relationship with your members. Surveying Your Providers Since a Net Promoter Score is based on survey responses, a series of categories are used to segment the providers in your network. An NPS survey asks responders to scale answers from 1-10. Here’s how the responses are grouped:
A

Detractors (0-6)

Unhappy providers
A

Passives (7-8)

Satisfied but not excited
A

Promoters (9-10)

Providers that are loyal to you
You get your Net Promoter Score by subtracting the percentage of promoters from the percentage of detractors. NPS Benchmarks reports that on average, consumer-facing healthcare companies have a NPS of 67, while an average score for an insurance company is 42.6. The industry average for healthcare insurance companies is 0. “Scores higher than 0 are typically considered to be good and scores above 50 are considered to be excellent,” writes CustomerGuru, who reports that a large health plan with a Net Promoter Score of 1 is considered “good”. The large gap between other industry scores, even healthcare provider scores and insurance plans, suggests that health plans have some catching up to do when it comes to NPS metrics. “We shouldn’t merely aim to exceed standards set by other industries, but rather hold ourselves to an ever rising standards of our own,” writes Tashfeen Ekram, MD for Becker’s Hospital Review. While providers seek to improve patient experience, health payers have a unique opportunity to join them in doing so by improving their relationship with in-network providers.
Why Should You Care What Providers Think? It surely comes as no shock to you when we point out that the relationship between providers and payers isn’t all that great. Communication break downs that lead to provider abrasion are common. But tracking and aiming to improve a Net Promoter Score between providers and payers is a unique opportunity to forge a more-powerful partnership. Given the blurring lines between payers and providers and the data behind member satisfaction (which depends on provider service), most health plans have a pretty good idea that keeping providers happy is gaining importance. Nonetheless, approaching provider satisfaction as an actual goal may be a disruptive idea at your health plan. Treat providers as customers? Sounds odd, you might think. But the most powerful companies know that building brand loyalty is important to every business relationship.

Tips for Your Net Promoter Score Survey

This could be due to several factors. For one thing, providers have traditionally done well with their patient Net Provider Score. In many instances, when care is poorly coordinated with insurance companies, claims are denied, or bill costs shocking, consumers tend to blame health plans. But providers can change that perception if they are informed with knowledge that is beneficial and specific to patients. Communicating effectively with providers, who in turn can better coordinate care (and be mindful of treatment costs), will translate into improved Net Promoter Scores for both members and in-network care providers. “As the industry shifts to value-based performance – driven by the health care consumer – plans must shift from a B2B to a B2C model to be successful,” writes Novu, a provider of health plan member engagement technology. How Pareo® Supports Net Promoter Score Improvement Companies with high net provider scores have a few things in common: They are reliable, fast, quick to communicate and easy to access, and they make the experience personal. Health plans are often too complex and too siloed to achieve this level of service. That’s where Pareo® makes a difference. With total transparency across your health plan’s departments, answers to questions can be delivered in real-time. More business partners can plug-in with a faster implementation time and higher-level of coordination, all thanks to the technology that ClarisHealth delivers. Some of our health plan clients have found such success with Pareo® that they are already scaling our processes towards improving provider relationships. In fact, health plans are increasingly interested in Pareo’s provider engagement module that greatly streamlines financial transaction management among the payer and provider and significantly reduces friction inherent in traditional, paper-based methods. By sincerely soliciting feedback from your providers, your health plan can improve. And when issues arise or as the industry continues to shift, your providers will be more likely to stick with you if your health plan has put in effort to improve your Net Promoter Score.

Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.

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