How to Create Member Experiences that Build Trust, Loyalty, and Retention

CG Adams: Hello, everyone. And welcome to the Payer Principle, a Salesforce Healthcare Podcast, created exclusively for payers. I'm your host, CG Adams. On the show you'll hear insights from healthcare industry experts in trailblazer organizations on all things payer, such as trends, business challenges, and the latest technological solutions. Today's episode focuses on member experience and how healthcare consumers are demanding a more connected and personalized experience from their health plans. I'm joined today by Joe Police. Joe is currently a payer go to market leader at Salesforce with nearly 30 years of experience in healthcare, having worked for a major payer, such as Molina, United, and Cigna. Joe, welcome to the show. It's so great to have you on today.

Joe Police: Thank you CG. I'm honored to be here with you today and looking forward to the discussion.

CG Adams: So let's go ahead and jump in. According to the Salesforce Connected Healthcare Consumer Report, 67% of consumers would switch or supplement health insurers after a bad experience. Why does member experience matter so much right now, Joe?

Joe Police: Payers simply can't afford to ignore their experience any longer. And they know that. Member expectations have been changing with society's technology advancements. And the bar has been raised to a new level, given technology disruptions from other industries, such as fast food apps, driving apps, et cetera. Member's expectations are now the same for health insurance as they are for any other industry.

CG Adams: So the consumerism of healthcare is really lending itself to consumers wanting more from their healthcare organizations. I want to dig into what are some of the latest trends around member experience. Can you tell us a little bit about those?

Joe Police: Sure. Obviously the biggest trend is around virtual health, such as tele- health. And not only the expectation, but the need to meet and treat has changed drastically. So many see more value in telehealth services because of a greater convenience or affordability. Also, the advantage of relatively healthy patients staying out of the physical provider location, and therefore slowing the spread of the viral infections, like say the flu, or COVID. And that translates to a healthier population. Beyond tele- health, we're seeing providers looking heavily for support from AI analytics tools, such as Tableau. Healthcare insurers are beginning to focus on social determinants as a way to boost health care outcomes and reduce costs as well. Payers waving the out of pocket expenses for COVID- 19 are considering when and if to roll back how they handle COVID and how they do authorizations, et cetera. So they're looking at the entire spectrum of how they approached healthcare.

CG Adams: Joe, how do these trends translate into strategies that payers implementing when it comes to delivering a better member experience?

Joe Police: We see payers really wanting to transform the member experience. And we define transforming member experiences as significantly improving communication and data flow across consumer marketing, member sales, member service, care management, et cetera, to create a 360 degree view of the member. There's three areas that really affect transforming member experience. So the first one is, omni- channel engagement. And that is kind of the key funnel for this type of engagement. And the message needs to be the same across the channels. Is it the same across the channels? Is the information gathered fueling next best actions? Are the members preferences being tracked? Are they being respected? And are they being used even?

CG Adams: And when you say member preferences, you're referring to how a member wants to be engaged by their health plan, correct?

Joe Police: Exactly. So, there's a difference between, say the senior citizen that only likes to speak on the phone, versus say the young 20 something who can speak through their app. So how do they like to work to communicate? That is kind of what we're talking about. That translates into the digital engagement. So it's the use of the channels and real- time data to meet the member where they are, maybe say at the point of service. How do we get the information to them when they show up at the doctor's office, when they're in the ER, when they are at the pharmacy, whatever the case may be? And then the third would be interoperability, sharing EHR medical information in safe and specific ways. All this translates into an experience. Did we make them feel satisfied? Did we make them feel answered? Most importantly, did we make them feel valued? They'll remember those feelings. They won't necessarily remember what was said on the phone. It's a fully integrated system that makes that achievable.

CG Adams: I want to unpack that third trend, interoperability. Earlier this year, the centers for Medicare and Medicaid services, CMS, announced a new interoperability rule that requires many types of insurers to provide electronic health data in a standard format by 2020. What effect do you feel that that rule and those new requirements are going to have on member experience?

Joe Police: It's an incredible step in the right direction and for the future of healthcare. Things like member access to data via API, claims, and counters, formulary data, as well as clinical data exchange that will facilitate moving between providers for a more seamless experience, and streamlining, prior authorizations, medication reconciliation. All this stuff is a real net benefit to the member. However, it won't be a panacea as we in healthcare are so far behind other industries. And I think that for the future of healthcare, it's vital that we must get to a point where we have a better system of interoperability.

CG Adams: I completely agree. I think that having more interoperable systems is going to be huge when we think about the impact to making member experience be more comprehensive, be more digitally sound, be less fragmented. So Joe, where do you see the industry going from where it's come from? We've come a pretty long way, don't you think, when it comes to member experience?

Joe Police: Boy, have we. That's a great question, CG. I can remember, gosh, back in 1992, when I was a customer service rep at Cigna. And having a phone call from a senior citizen, who said," I just have a few claims that I'm just really having trouble with." And I said," Well, just send them to me." And this was in the early nineties, so you didn't have digital integration. It was just a phone call and mail. And so she sends me this shoe box full of claims that spanned like five years.

CG Adams: Wow.

Joe Police: Yeah. And so the first call resolution was not going to happen with that one. But you think about an experience like that, and it took me a month to get through all of her issues, but I did. And that was the way things were back then. Now, you have this modern experience of say tele- health, and you have a member in a tele- health engagement with their primary care physician, who provides a referral. And you could potentially have that referral authorized in the middle of that call. And multiple people going in multiple directions to wrap their arms around this member digitally. And I think that if you want to know where it's come from, it has come from shoe boxes full of claims to multiple people surrounding a member with care and getting them the care that they need. And I think that that's exciting.

CG Adams: Well, I'm glad that you no longer have to worry about seniors sending in claims physically via shoe boxes. We definitely have made some huge strides as an industry when it comes to delivering a better member experience. We have some room to go, but I think both you and I are pretty optimistic about where we're headed. Finally, I want to hear your thoughts on COVID- 19 and how it's really changing the healthcare landscape. What are your thoughts?

Joe Police: With the outbreak of COVID now, we have not just an opportunity, but a duty to bring the full capabilities and resources of the industry to take care of members and patients, not just manage their care by being consumed by KPIs and data. The focus is shifting to addressing social determinants, risks, availability of data, and ease of use of self- service, options that bring about a more cohesive experience.

CG Adams: Joe, thank you so much for joining us today on the Payer Principle Podcast and for all of your insights.

Joe Police: Oh gosh, thank you, CG. I really appreciate the opportunity.

CG Adams: To learn more about our payer solutions, visit salesforce. com \ healthcare. I'm your host, CG Adams. Thank you for listening.