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Analytics Magazine

Healthcare Analytics: Curing what ails

July/August 2015

How interaction analytics is transforming the health insurance industry.

Charlie BitzisBy Charlie Bitzis

It’s no secret that with the introduction of the Affordable Care Act (ACA), the healthcare landscape has changed dramatically for all involved in the industry, from doctors to patients to health insurance providers. These new regulations and changes have generated a significant shift in how members are able to approach their healthcare options, leading to a much more consumer-driven marketplace.

In order for insurance providers to keep up with the rapid pace of change, they need a method of tracking the impact of all of the changes to their business, from ensuring they are remaining compliant to areas like the “80/20 Rule” to tracking how they are responding to their members’ requests and complaints. The insights necessary to accomplish this are locked away in the millions of customer interactions that flow in and out of the insurers’ contact centers on a daily basis. One critical key that leads to the discovery of these insights is understanding what that data is saying and enacting positive operational changes based on the results.

The bottom line is that health insurance providers are facing interaction management issues more and more often. Below are four key areas where healthcare providers are finding the power of interaction analytics is driving significant change in the industry.

1. Discovering new sources of revenue.
As the Affordable Care Act (ACA) continues to take shape, health insurance providers are faced with new regulations that limit the amount of money that can go toward business processes outside of care, such as administrative functions and overall profit margins. As a result, companies are looking for ways to offer the best service possible while remaining compliant and increasing revenue. Since there is a finite amount of money that can be spent in other areas outside of direct member care services, healthcare companies are working to identify areas within their current cost structures that can be changed in order to save money over the long run.

Interaction analytics provides companies with the power to deep dive into their customer interactions and find the root causes of the issues that are creating avoidable costs. These issues can range from finding the problems that most likely result in repeat calls to which particular part of the ACA is the most difficult for agents to explain. Through the use of interaction analytics, a healthcare provider can identify those particular areas and begin to make changes based on that information. For example, knowing that unresolved claims on a specific type of billing issue most often leads to members calling in multiple times, a company can find out what’s driving the behavior, build a better process for handling claims and, ultimately, reduce the number of repeat calls. Not only will the reduction of call volume save the provider money, it will also ensure that its members are far more satisfied and much more likely to continue using the provider in the future.

Interaction analytics is pushing positive and profitable change across the healthcare industry.
Interaction analytics is pushing positive and profitable change across the healthcare industry.

2. “Consumerization” of healthcare. Along with new and ever-changing regulations, the ACA has also brought a new and heightened level of consumer choice to the healthcare market. As exchanges at the state and federal level began developing, members obtained more control of what levels of coverage and provider they choose to use. This change is a radical shift from the business-to-business model so many providers are familiar with, and many companies are finding that the strategies that have worked in the past are fast becoming outdated.

As a result, healthcare providers have had to shift their focus to accommodate not only the large business-to-business transactions they still work with, but also the more individually based member interactions. In order to be as successful as possible in this endeavor, companies have to rely on interaction analytics to point them in the right direction. Having the ability to analyze each and every customer interaction enables providers the opportunity to understand what happens during the enrollment process and the member’s journey throughout the life of the relationship. As a result, healthcare providers have the ability to create more effective enrollment processes and ensure that they are able to meet their members’ needs and ensure a higher rate of member retention.

3. Member satisfaction. As healthcare becomes more of a consumer-driven industry, providers increasingly must consider their members’ satisfaction levels. Since the introduction of the Health Star Rating System, consumers have more input to their healthcare experience than ever before. One key result of this new system is that payers have to ensure that they are providing the best possible service to their members or face the potentially negative reviews of their marketplaces, leading to the loss of both revenue and member enrollment.

Interaction analytics provides a way for healthcare providers to not only keep track of how well they are meeting their customers’ needs, but also quickly identify the areas requiring improvement before the issue has a significant negative impact. By analyzing all of their customer interactions, providers have the ability to spot emerging trends or areas of growing dissatisfaction among their member base. By taking advantage of that information, payers have the ability to proactively fix the issues before they cause a decrease to their Star Rating. The benefit is two-fold: provide proactive and excellent customer service while maintaining a high Star Rating.

4. The future of analytics and healthcare. As the healthcare industry as a whole moves into the future of digital and remote medicine, understanding and acting on solid interaction analytics data is going to be exponentially more important to providers. As the Healthcare Effectiveness Data and Information Set (HEDIS) becomes a more widely accepted tool, collecting, interpreting and utilizing that data will highlight the companies that are the most successful, as well as those that find themselves falling behind.

For example, as health outcome programs become a more regular part of healthcare provider solutions, it is going to become more important than ever for providers to have the ability to match interaction information to the actual health outcomes of members in order to best track successful care. Understanding that regular phone calls to remind patients to take medication or to encourage them to stop smoking are actually working well will further push adoption rates of these types of programs. In addition, interaction analytics can allow providers to quickly identify programs that aren’t working, resulting in positive organizational changes, as well as acting as a cost-saving measure.

Conclusion

As the strict nature of regulations evolves and increases and as more and more customer interactions move to a purely digital format, managing that information in an informative way is going to become increasingly important. Through changing inefficient processes or shifting to a more customer-focused approach, the power of interaction analytics is pushing through positive and profitable change across the healthcare industry.


Charlie Bitzis (cbitzis@nexidia.com) is a business principal leading healthcare and general verticals at Nexidia (www.nexidia.com), a provider of customer interaction analytics solutions for business transformation.

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