Healthcare CX: How to Go from Ailing to A-Class

Consumers indicate that four healthcare journeys—getting coverage, understanding benefits, finding care, and saving and paying for care—are of high importance yet deeply unsatisfying, according to McKinsey.

This is a damning assessment for a big part—if not all—of consumers' healthcare journeys. Other statistics tell the same story:

  • Forrester Research, in its U.S. CX Index, reported that health insurance customer satisfaction, average to begin with, has been on the decline since 2021, landing in the bottom quartile in 2023.
  • And J.D. Power noted that health plan member satisfaction declined in 2023 vs. 2022, largely driven by a drop in satisfaction with customer service.

So, what should healthcare organizations—payors and providers alike—do to improve customer service and CX? Here are some answers.

1. Digitalize the service.

Using digital channels for customer service has become a secular trend cutting across all generations of consumers and all industries, accelerated by smartphones, messaging apps, and COVID-19 lockdowns. Consumers want to do more digitally beyond simply scheduling appointments or checking their bills. They want to accomplish more complex tasks, such as human-assisted digital filling of complex online forms, remote monitoring of health metrics, and more. They want proactive digital service and wellness coaching over time. Where they are not able to self-serve, they want answers through human-assisted digital channels such as live chat and messaging apps. This would require healthcare organizations to go beyond the basics and provide customer service through touchpoints like next-gen chatbots, secure messaging, live chat, co-browsing, in-app service, notifications, and automated coaching. Moreover, video consultations can reduce the need for unwarranted office visits, which will help ease demand for in-person care and provide relief to over-stressed health workers.

2. Hub the conversations.

While digital self-service is seeing increased adoption, patients also demand human assistance over digital channels like messaging and chat and, if all else fails, over the phone or in person, and they want a seamless, context-aware journey across these touchpoints. If patient conversations are not all hubbed in one place, front-line healthcare workers will not have 360-degree context, an absolute must for life-critical industries like healthcare. Without full context, they wind up asking the consumer to repeat information, a big no-no for good CX, and worse yet, make poor decisions or write sub-optimal prescriptions.

3. Hub the knowledge.

When asked to name the biggest pain point in customer service, consumers overwhelmingly point to the lack of knowledge and expertise among front-line employees. Here are some stats to ponder:

  • Sixty-five percent of patients said they get different answers for the same question across touchpoints, according to a survey by Dimensional Research on our behalf.
  • The numbers were even worse in a Forrester survey, with 67 percent of patients saying front-line employees either did not know the answer or gave inconsistent answers for the same query.

The cause? Inconsistent knowledge silos and haystacks of documents with answers buried in them are among the top culprits. The solution? A knowledge hub with trusted content, conversational AI, generative AI, integrations, and analytics, all unified and orchestrated in one place. This approach will eliminate silos and ensure that the knowledge used on the front lines is correct, consistent, and compliant with regulations.

4. Augment AX (Agent/Advisor Experience).

More than half (52 percent) of consumers can't navigate health plan options on their own, driving up unnecessary phone calls and service costs. This translates to $4.82 billion in costs, per Harvard Business Review.

The realm of health plans has become rocket science, befuddling consumers and front-line employees alike. Options are many, complex, and sometimes misleading because of brand names used by carriers.

It is not uncommon for advisors to recommend sub-optimal plans or for consumers to pick such plans through self-service, where they spend more money than they would have in a more tailored plan. The solution is to provide AI and knowledge-assisted plan selection and customer service guidance to front-line advisors. Our payor clients are seeing significant improvements in agent/advisor experience and a reduction in training time with this knowledge-enabled approach.

On the provider side, the U.S. could see a shortage of up to 120,000 physicians by 2030, per the Association of American Medical Colleges. Per AMA, nearly 50 percent of U.S. physicians are already over age 55, and 67 percent of doctors experienced burnout during the pandemic, with many of them planning to cut down work hours or leave the profession altogether. All this when the U.S. population continues to grow!

Provider organizations will have to depend more on other front-line employees, such as nurses and nurse practitioners, to close some of the gap. However, their education and training limits them to patient queries that are on the simpler side. Applied with human supervision and compliance to the right queries, AI and knowledge-enabled guidance can help take them to the next level in their diagnostic and prescriptive capabilities.

5. Select the right solution partner.

Make sure you pick a partner whose technology is proven and who has succeeded at scale in healthcare customer service and knowledge management. In addition to top-rated technology, does the vendor provide end-to-end services, including training/education, implementation, and managed services? Does it have a formalized customer success program? Does it offer risk-free production pilots—not just a toy sandbox—to try out its solutions with expert guidance free of charge in the pilot phase? Vendors' willingness to put real skin in the game shows their commitment to your success and confidence in their own solutions.

Here are some at-scale success stories from our clients who leverage knowledge and AI-enabled customer service to elevate CX, AX, and operational performance:

  • A premier health insurance firm reduced agent training time for handling complex health insurance queries by 33 percent even as its agents—more than 2,000 of them—had to go remote overnight due to COVID lockdowns. In fact, our knowledge platform helped them meet all 30 of their goals, including improvements in average handle time and first contact resolution.
  • A large government healthcare agency experienced phenomenal success with our knowledge management platform. The solution empowers 25 million users and 128,000 contact center agents and other customer service personnel with consistent and accurate information and AI-powered conversational guidance, while being compliant with regulations.
  • A nationwide vertically-integrated U.S. retail healthcare chain provides proactive digital customer service to more than 100 million consumers through knowledge-powered notifications across SMS, email, and voice on topics such as prescriptions, enrollment, and benefits. The company sends more than 2 billion notifications per year, reducing unwarranted incoming calls, relieving front-line employee stress, and improving customer satisfaction, all at the same time.

Prioritizing digital channels, unifying and orchestrating conversations, knowledge, and AI in a hub to eliminate silos and guide front-line conversations and processes, and working with a proven solution provider will elevate healthcare CX from ailing to A-class!

Anand Subramaniam is senior vice president of global marketing at eGain.