Can Your Infrastructure Support a Flawless Customer Experience During Open Enrollment?



Rolling open enrollment is an opportunity for health insurers to increase membership among the most lucrative customer populations, but providers are equally vulnerable to customer dissatisfaction during these crucial periods. One factor is the abundance of call center legacy systems, and provider consolidation has increased these complexities from state to state, putting unprepared providers at risk of losing market share and brand reputation. Further, many consumers have barely shaken off the negativity from web site outages experienced during enrollment for the Affordable Care Act.

Providers can take preventative measures ahead of open enrollment periods to improve the infrastructure for their call centers. IVR testing solutions provide automated discovery, scenario testing, monitoring, and load testing. Healthcare providers that take these actions and also review all customer-facing channels to ensure quality have a competitive advantage as deadlines approach.

Insurance providers are moving toward online and mobile services, but the call center remains a crucial touchpoint for members, particularly when they are most in need, confused, or upset. The statistics below demonstrate the extent to which consumers are frustrated with the service provided by healthcare organizations:

  • 2013 Harris poll reveals that just 7 percent of respondents trust American insurance companies. Only industries like tobacco, social media, managed care, and oil companies fared worse.
  • 27 percent of Americans rated satisfaction with their healths plan as a five out of 10 or less in a 2015 ConnectedHealth survey.
  • Wait times at some call centers can be up to three hours, and patients have no choice but to simply wait on hold for this essential service.

While not favorable, these results signal room for improvement, particularly in the service provided during open enrollment periods, where customers might already be overwhelmed.

The Call Center's a Ticking Time Bomb

Those closest to the call center know that the interactive voice response (IVR) infrastructure has issues, but many organizations might not be aware of the complexity IT departments face in addressing the management of multiple systems.

Even when a healthcare provider has never acquired another company, they can have different IVRs serving each state, with a minimum of 50 separate systems likely for customer care. If a company has had an acquisition, it could have closer to 100 separate call-in systems for customer care. A survey of all of the major healthcare providers found no fewer than 60 separate systems for handling incoming customer calls.

To deal with surges in the call center, healthcare providers have outsourced call center professionals on call for peak times. So, the alternative to an efficient IVR is staff, which is costly.

Most IT departments have no way of mapping the call scenarios except to hire testers to call in manually and try each button one by one. It's nearly impossible to map every possible scenario for every caller and every instance for 60 different systems using this method.

Even if organizations have mapped and manually tested the main cases, this is expensive, time-consuming, and doesn't always pinpoint reproducible scenarios. Most IT departments have no systems in place for monitoring the paths of actual calls, meaning they can only identify pain points when customers complain. Even if customers report problems, it's often impossible to reproduce the pattern that caused the failure.

Systems are available to automatically map all of the IVR scenarios in any system, and provide monitoring of these systems.

A Clear Opportunity

Open enrollment for 2017 has begun, and it's a huge opportunity for healthcare providers. With healthcare coverage now required by law, people who have never applied before will be enrolling now. New members are often the most profitable members: younger people who aren't worried about their health. At the same time, these consumers are the most sensitive to receiving great customer service. Any customer experience advantage that insurers can create over their competition will lead to a larger market share of those new customers.

Better customer service is essential for growth of health insurers and healthcare providers. In addition to testing and monitoring for optimum call center performance, it's also important to review all components of the customer experience. Preparation for rolling enrollment service should include the following:

  • Evaluating call sound quality and eliminating complicated phone menus;
  • Reviewing web site content for clarity;
  • As with the call center infrastructure, testing, testing, and testing web site performance.

Affordable, flexible systems exist to ensure that the systems that allow customers to interact with providers are working every time, everywhere, to deliver a satisfying customer experience. Preparing now will ensure that providers sail through open enrollment periods with more ease and confidence.


Bill Aston is general manager of the Americas at Cyara.