Posted by Dave Palmer on Dec 7, 2020

The American healthcare industry enjoyed an infamously privileged status for a long time.  For decades, it didn’t much matter how consumers felt about their member experience. Traditional competition was minimal because most peoples’ choices were made by their employers. Complaints rarely made it beyond one’s immediate social circle – which was itself generally comprised of people equally unhappy with their own member experiences.  

Over the past ten years, three enormous but unrelated shifts in the market occurred that fundamentally changed how healthcare consumers and providers view their relationships to one another.  


The Affordable Care Act 

In 2010, the Affordable Care Act (ACA) created a health insurance marketplace, where consumers shopped for insurers in much the same way that they’ve long shopped for other imposing-but-accountable service providers, like banks. In addition to infusing a healthy dose of competition into the system, the ACA mandated that measures of member satisfaction be gathered and used as a basis for Medicare and Medicaid reimbursement.  

These byproducts of the ACA obligated payers and providers to focus more directly on improving the member experience, which often meant contracting with specialized business process outsourcers (BPO) like Everise, able to economically provide high-quality member support. 

The ACA also generated more paperwork – such as new enrollments and claims –for healthcare payers, who responded by outsourcing those processes as well. These three factors were important contributors to the 14% jump in the size of the healthcare BPO market in the years following the ACA’s enactment. 


Social Media  

The rapid emergence of social technologies in the years following the ACA allowed members to express their sentiments far beyond the people around them. We’ve all seen how both good and bad member experiences can achieve viral status and gain a global audience within hours. In a culture where even anonymous online reviews carry as much weight as personal recommendations – and are often trusted even more than one’s own physician – the importance of better understanding the root cause of member dissatisfaction and pre-emptively addressing these became clear. 

Successful root cause analysis requires access to large datasets, such as those being amassed daily in tens of thousands of interactions between members and support agents. The Everise answer to this question is called Systematic Insights, and it drives enormous value to our healthcare partners by identifying deep, non-obvious drivers of member dissatisfaction, backed by methodical A/B testing to validate both hypothesis and solutions. 

In one recent example, the Systematic Insights team hypothesized that tweaking a single approach to internal coaching could increase the incidence of “perfect calls” (the Holy Grail of member satisfaction) and help our partner gain all the brand-building benefits that come from logging more of those gems. It took specialized skills and tools to identify both the issue and the solution, but the tests proved conclusive, in the form of a whopping 10% jump in perfect calls. 

This is the kind of thinking required of healthcare delivery organizations in the social age.   


A Global Pandemic  

In 2020, a third factor upended the status quo yet again: Covid-19. 

Among other things, Covid-19 swiftly eliminated any efficiency benefits realized by centralized member services, which had long been foundational to the BPO playbook as it ensured efficiency, quality control, and data security compliance. Yet over the course of a week in mid-March, centralized contact centers shut down globally, with only those BPOs able to quickly and effectively send member support agents home to work left standing. 

As the dust settles, it’s apparent that Covid-19 had a surprisingly positive impact on member experience, and I’ll dig into why that’s the case in my next post, coming soon. 



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