The CX factor: Driving health plan growth & retention

In our latest whitepaper with Becker’s we had the opportunity to speak with leaders from Regence, Commonwealth Care Alliance (CCA), Capital District Physicians’ Health Plan (CDPHP), McKinsey and Highmark Health about the value of consumer experience (CX) for health plans. These executives have undertaken successful CX transformations and shared key insights on how they’ve been able to achieve business objectives, increase engagement and stay ahead of the competition. 

Member retention and growth is a key value driver that commonly emerges in CX initiatives for payers. Transforming CX contributes to member satisfaction, influences a member’s decision to renew policies, attracts new members, and ultimately leads to business success. But, one of the main challenges we heard from leaders is, how can they actually deliver and quantify this value in the short-term to gain the appropriate buy-in?

Navigating the path to value 

From segmentation to personalization

Delivering a personalized and relevant CX has become a crucial differentiator for payers. Forget about the legacy approach of categorizing members based on generalized characteristics like age and gender. We’re talking about true personalization. Health plans need to dig deeper, exploring members’ preferences, barriers to care, and even their family history. It’s like creating a tailor-made suit for each individual’s healthcare needs. But here’s the catch: to make this happen, payers need the right data. It’s important to establish a comprehensive data strategy that addresses data collection, integration, quality, and governance. By investing in data management systems and tools, health plans can ensure data accuracy, accessibility, and security, enabling effective segmentation and personalization. Payers can collaborate with technology partners to access additional data sources and capabilities. Integrating data from electronic health records, wearables, and other sources with a CX platform can enhance personalization efforts and provide a more holistic view of each member.

The perils of point solutions

To improve retention of existing members and to attract new members, it’s essential to reduce friction, meet people where they are in their health journey and deliver truly engaging programs through the digital tools they want to use. Health plans often stumble when they rely on niche benefit vendors with point solutions that create a siloed member experience. It’s like having puzzle pieces from different sets—they just don’t fit together. Instead, payers must strengthen their capabilities across the board to build integrated, omnichannel experiences. By adopting a unified digital platform, focusing on user-centric design, implementing a comprehensive data strategy, and working with the right partners, payers can overcome these challenges and provide members with a seamless experience throughout the healthcare journey.

Next gen CX platform

A unified CX platform harnesses the power of data and analytics to deliver personalized member experiences and omnichannel interactions to consumers. By leveraging insights derived from member data and consolidating various processes, payers can eliminate silos and tailor their communications, recommendations, and interventions to the specific needs and preferences of each individual. “When you think about a digital platform and the capability it unlocks, it really needs to be a place where someone can go to access all of their digital healthcare needs,” said Chris Trant, VP, Customer Experience and Revenue Operations at CDPHP in our latest whitepaper with Becker’s. “There must be one location for members to go to. There can’t be many point solutions that are delivered through a care journey.” Whether it’s providing targeted health tips, suggesting relevant resources, or delivering personalized and proactive recommendations, a unified platform enables health plans to foster meaningful and personalized engagements, leading to increased member satisfaction and brand loyalty.

Metrics that matter

While CX transformation can deliver tremendous value, it takes a concerted effort to evaluate the effectiveness of CX initiatives and quantify the impact on member retention and growth. Sample drivers that can be measured to assess both short-term and long-term value include: brand image and satisfaction, member churn rates, and member acquisition. 

The pulse of brand excellence

Conducting regular C-SAT surveys allows health plans to gauge member satisfaction and assess the health plan’s brand image. Additionally, quick NPS or pulse surveys conducted after an experience or activity is complete can be built directly into digital health tools to measure the effectiveness of the interaction, sentiment and overall satisfaction with that activity/interaction.  “Any time people change their health plan, it creates a point of friction,” said Stacy Byers, SVP Experience, Design and Digital, Highmark Health. “That friction really pops in an NPS survey. Then we can understand the value of guiding a member through that transition.”

Short-term value can be measured by tracking changes in satisfaction scores over time, while long-term value can be evaluated by monitoring brand perception and loyalty metrics.

Make members life-long customers 

An engagement analysis can be conducted to assess how a high-churn population engages with specific services and channels. Analyzing patterns and identifying pain points can provide insights into short-term value opportunities, such as addressing service gaps or improving communication strategies. In the long term, tracking retention & churn rates and analyzing trends can help identify systemic issues and drive strategic improvements.

Unleash the growth spurt

Monitoring the customer growth rate of the health plan’s customer base, particularly in specific markets or demographics can provide insights related to member acquisition. Short-term value can be observed through spikes in new member acquisitions, growth rate or conversion rate of online/digital channels, while long-term value is reflected in sustained growth and market expansion.

The transformative power of CX

Membership retention and growth are crucial for health plans to thrive and be successful. It not only ensures a stable revenue stream, but also provides cost-effectiveness and an advantage in the current highly competitive environment. By prioritizing engaging and highly personalized member experiences, payers can differentiate themselves, enhance their brand image, and become the preferred choice for both existing and potential members.  Payers that invest in building stellar member experiences and those that can quantify and measure the value of those experiences, will position themselves at the forefront of the industry and build long lasting relationships with their members.  

To gain additional insights from leading health plans on how to deliver business value through CX transformation, download our latest whitepaper with Becker’s, “Transforming the Member Experience to Unlock Business Value”.