Healthcare Enrollment in the Age of Digital and Unknowns

When millions of Americans identify, compare, and select a healthcare plan this year, they will expect a shop and enroll experience that is easy and personalized – more like what they see in familiar retail environments. What usually happens, however, is anything but.

Instead, consumers get a decades-old healthcare experience. Information is hard to find and understand because of poor UX and heavy industry jargon. It’s nearly impossible to easily compare plans. Much of this friction is due to outdated technology.

On the payer side, this old technology also makes it difficult to streamline sales operations in a highly regulated, fluctuating industry. What’s needed is an agile platform and a digital middle office to simplify the product life cycle, automate eligibility rules, and create workflows to quickly guide members to what they’re looking for.

As if that wasn’t enough, the COVID-19 pandemic has compounded these challenges with unexpected special enrollment periods, coverage updates, and an influx of member plan changes. The past year alone has taught payers that digital transformation is more essential than ever. It’s the only way for payers to stay competitive, maintain efficiency, and thrive during constant change.

Because members rarely switch plans, Medicare Advantage is one area of the healthcare industry that must take shop and enroll very seriously. In fact, for the 2017 plan year, less than 10% of members voluntarily switched to another payer.

Additionally, payers need flexible technology to market attractive premiums and new supplementary benefits. In 2019, the Centers for Medicare & Medicaid Services (CMS) expanded the definition of supplemental benefits. Then COVID-19 hit and along with it came an additional expansion of midyear benefit enhancements to cover costs associated with the public health emergency.

During shop and enroll, payers have an opportunity to provide an intuitive, guided omni-channel solution to members and customers that:

• Compliantly manages events and marketing
• Captures scope of appointment
• Guides personalized plan options and selection

This transparent, easy-to-understand approach becomes foundational for the new customer experience measure that will soon account for 57% of the total Star Rating in 2023.

The answer for better shop and enroll experiences is a single engagement platform that brings together all member and customer data. This is how payers can deliver amazing experiences. Additionally, using technology that is built for a specific industry, like healthcare, eliminates the need to develop time-intensive custom solutions. This allows companies to go to market faster with the improved experiences we know consumers expect.

That’s why we provide purpose-built solutions for the healthcare industry on Health Cloud, the world’s #1 CRM reimagined as a healthcare CRM. Health Cloud helps payers achieve greater automation, improve user experiences, and enhance agility across the health plan enterprise.

Salesforce has been at the forefront of helping healthcare members and customers for over 20 years and continues to solve the industry’s most complex challenges for payers. Here’s how we help payers offer an improved healthcare member experience by transforming sales operations and engagement to drive acquisition and retention.

Health Cloud creates a unified member profile across all touchpoints before and after enrollment by connecting pertinent data, marketing campaigns, and privacy management. A holistic view helps payers personalize the experience to build trust and loyalty with prospective members and customers.

Health Cloud consolidates and integrates existing record systems in one place to effectively manage benefit design, rating calculations, and eligibility rules across business lines and product types. This way, changes are a breeze and become quickly extendable into more user-friendly, accurate experiences.

Health Cloud eliminates the manual and confusing benefit shopping process with prebuilt workflows, services, and AI to make member enrollment a smooth experience. Internal agents, brokers, or healthcare consumers will encounter a guided and consistent experience to find the right coverage based on eligibility and needs on any channel or device.

Health Cloud enables brokers and members to easily manage benefit inquiries, personal information, resources, and upcoming renewals via self-serve portals. Payers get to prioritize the most relevant tools anytime and anywhere and eliminate long call center waits.

What was once a future opportunity for payers is now a current reality. If you aren’t already thinking about how to use technology to transform your shop and enroll experience, it’s time to start. The path many health plan providers take to achieve this is one with complete industry-specific solutions like those we offer in Health Cloud.

To learn more about how Health Cloud can help you deliver a positive healthcare member experience, visit the Connected Healthcare: Moments That Matter for Payers hub.