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Healthcare disparities persist despite heightened awareness and ongoing efforts to address them. Consider this: six out of ten people are currently battling at least one chronic illness. And as if that’s not concerning enough, one out of every five people struggles to consistently fill their prescriptions. Simple yet powerful interventions, like nudging high-risk individuals to schedule wellness exams or ensuring everyone gets timely access to care, can yield substantial impacts on both health and financial outcomes.
With the right data at their fingertips, health plans can match the perfect insurance plan tailored to each member, amp up their focus on preventive care, and seamlessly bridge gaps in both care access and treatment. A data-driven approach goes beyond just improving health outcomes, enabling better disease detection, prevention, and care, improving Star Ratings, and leaving more money on the table to drive further improvements.
The question is: how do we make data-driven approaches a reality on a broader scale?
Scaling data-driven approaches for impact
Unlocking widespread access and affordability to data-driven strategies faces numerous hurdles. First and foremost, the critical importance of risk management and regulatory compliance cannot be emphasized enough, as governance is essential for all healthcare data initiatives. Additionally, the ever-evolving nature of data insights presents continual challenges in maintaining data currency. Moreover, determining data relevance and optimizing the return on investment (ROI) of data-driven solutions poses a significant obstacle.
Although there’s no quick fix, organizations that effectively implement AI and analytics solutions are primed to enhance their business outcomes by leveraging data sharing as a powerful asset. While AI and analytics are powerful tools individually, their combined potential is even greater. By leveraging both, health plans can empower agents and members alike and focus on holistic member health.
Doing more with analytics
Utilizing analytics from a “voice of customer” perspective entails customizing culturally relevant communication and engagement to address members’ requirements at every step of their healthcare journey.
- Elevate operational performance: Comprehensive analytics (refer to Figure 1) offer detailed insights across various areas, serving as a cornerstone in enhancing agent productivity, streamlining operational processes, and minimizing risks. Ultimately, these efforts contribute to improved health outcomes and heightened member satisfaction.
Speech
Outcomes : Process adherence, agent compliance, and fraud detection
Process
Outcomes : Cost reduction and proactive mitigation of training issues, and improved software performance
Performance
Outcomes : FCR, FPR, and IVR optimization
Probability
Outcomes : Cost and workforce requirement forecasting, SLA compliance, resource optimization, churn analysis
Tactical
Outcomes : Task prioritization, queue management, automation, QA, and achievement of compliance and performance metrics
Strategic
Outcomes : Client portfolio optimization, technology improvement, global expansion, client satisfaction
Customer journey
Outcomes : Service, sales, and process optimization
- Advance health equity: Beyond clinical data, non-clinical factors like demographics, education levels, access to healthcare, transportation obstacles, and food insecurity influence up to 80% of healthcare outcomes. Through analytics and predictive models, health plans can delve into questions such as, “Do they have reliable transportation?” “What is their support network like?” and “Are they financially secure?” This allows for the creation of more tailored and impactful member engagement initiatives.
- Close care gaps: Harnessing in-year HEDIS data to forecast individuals at risk and pinpoint effective interventions is instrumental in prioritizing outreach efforts for addressing care gaps. This approach facilitates a more agile and responsive member journey. For example, health plans can pinpoint members afflicted by the top five chronic diseases and focus outreach initiatives on promoting preventive care, thereby enhancing outcomes.
For a prominent MA plan, embracing data-driven omnichannel engagement proved to be the game-changer, resulting in a nearly 3X increase in member appointments while slashing costs by an impressive 70%.
Driving change with AI
AI proves invaluable by empowering both agents and members. By integrating empathy training with advanced AI technologies, health plans can cultivate a dynamic and empowered contact center workforce. Meanwhile, AI is also crucial to developing and executing a proactive omnichannel outreach strategy, targeting enhanced member communication, health literacy, care management, and compliance.
- Empower agents with AI-driven onboarding, training, and knowledgebase solutions: AI chatbots streamline time-consuming hiring tasks and enhance the candidate experience by seamlessly engaging with candidates, guiding them to suitable positions, conducting behavioral and cognitive assessments, streamlining onboarding processes, and personalizing training programs. Additionally, an AI-powered knowledgebase integrated into the agent desktop offers real-time guidance, coaching, and alerts, accelerating proficiency, reducing handling times, enhancing speed and accuracy, and ultimately boosting customer satisfaction.
- Put members in control with self-service bots: Simplified customer experience through self-service bots empowers customers by enabling them to engage with health plans on their terms, enhancing Net Promoter Scores (NPS). Concurrently, this approach reduces the cost per transaction and overall support costs by encouraging customers to utilize self-service options, thereby decreasing billable agent hours, and promoting digital containment.
The deployment of Agent AI and chatbots played a pivotal role in a Health and Wellness Benefit Provider's journey, resulting in a remarkable boost in Customer Satisfaction (CSAT) to over 94% within two years.
Charting the course for inclusive healthcare
Disparities in health outcomes, spanning both mental and physical health, stem from a multitude of factors, including variations in health insurance coverage, access to care, and quality of services. Enhancing a healthcare organization’s ability to effectively analyze large datasets, not only promotes better health outcomes but also chips away at the trillions of dollars that chronic diseases cost the nation annually.
The exciting news is that the data we need already exists. Tapping into a unified platform on the cloud can ensure that member information is readily accessible in real-time and housed in a single location.
This consolidation of data empowers agents to connect members to all available benefits, improving clinical outcomes and lowering costs. More importantly, it helps plans keep pace with digital advancements in the industry, so they can continue providing a personalized and engaging member experience in the future.
This blog was written by Olga Golovin, Vice President – Client Solutions, ResultsCX