By Jill Warren
The healthcare payer landscape is volatile, but two challenges have remained consistent over the years: improving the member experience and lowering the cost of care.
Payers continually grapple with balancing cost containment and delivering a superior member experience. As healthcare costs continue to rise, payers are identifying and turning to innovative technologies, specifically artificial intelligence (AI), to streamline operations, personalize interactions, and enhance member satisfaction while managing financial pressures.
There’s one tactic that solves for both issues: omnichannel communications.
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Create exceptional member experiences
AI-driven member engagement platforms are revolutionizing communication and support. These platforms leverage chatbots, GenAI, and Agentic AI to provide 24/7 assistance for member inquiries, addressing frequent questions about benefits, eligibility, and claims. According to the 2024 Global Benchmark Report: The State of Healthcare Customer Experience, healthcare organizations should prioritize digital interfaces for patient interactions and data collection, aligning with the growing consumer preference for seamless digital experiences.
For example, one key area for technological integration is automated claims processing. When done right, it can dramatically and positively affect member sentiment. Traditional claims processing is notoriously time-consuming and prone to errors, leading to delays and frustration for members and providers. By implementing AI-powered systems, payers can automate the verification and processing of claims, significantly reducing administrative overhead and accelerating reimbursement. This not only minimizes costs but also enhances member satisfaction by ensuring faster and more accurate claims resolution.
In addition, personalized, omni-channel communication—phone, text, online chat, and a member portal—is crucial for driving member engagement, satisfaction, and the quality of care.
Tech-enabled platforms allow payers to tailor communication based on individual member preferences and needs. This can include emailing personalized educational materials, texting targeted health alerts, and providing customized recommendations for preventive care. By delivering relevant and timely information, payers can empower members to take control of their health and make informed decisions.
