Health insurance is a challenging industry to operate in, particularly with the constant evolution of relevant rules and guidelines.
In the case of the CMS Medicare Advantage (MA) Star Ratings program, for instance, change is enacted annually. So, every year, health insurance providers must struggle to adapt, since 50% of survey respondents identify the MA Star Ratings as a top differentiator for choosing plans, with 24%—nearly a quarter—naming it their primary criterion.
While such programs certainly facilitate positive outcomes—like improved medication adherence and the prevalence of preventative measures such as cancer screening, flu shots, and diabetic eye exams—they can also lead to organizations prioritizing regulatory compliance over other critical concerns such as customer experience (CX), even though, ironically enough, member experience is typically a key factor evaluated by said programs.
How, then, are health insurers supposed to continually comply with requirements and provide topnotch CX, while—let’s not forget—actually helping patients and running their businesses? One great solution is to partner up with a business process outsourcing (BPO) company, with extensive experience in CX for the healthcare and health insurance field.
Companies can rely on BPO experts to help them:
- Recruit and maintain a workforce that’s highly-trained in both the intricacies of healthcare and CX soft skills like communication, complex queries, and empathy
- Stay up to date and respond rapidly to changing regulatory standards, including the Health Insurance Portability and Accountability Act (HIPAA), the Payment Card Industry Data Security Standard (PCI DSS), and the EU’s General Data Protection Regulation (GDPR), as well as improving HEDIS and Medicare Star scores
- Ensure business continuity by alleviating staffing churn, reducing risk through strategically-diversified operations, and keeping pace with technological advances
- Improve operational efficiencies and bring down costsÂ
Those last two items, notably, are what organizations from nearly every field count on BPO to assist with, as CX continues to be the game-changer in virtually every type of business today. Yet healthcare and its related fields have been slower to take advantage of BPO support, burdened as the health industry has been by too many concerns, in recent years.
It’s those very burdens, though, that BPO can help ease, especially as consumer expectations grow to include such CX specialties as chatbots, self-service automation, and omnichannel customer support. With the right partner, health insurance providers can not only stay apace with industry changes, but actually get ahead and earn all those stars.
https://medcitynews.com/2024/04/star-ratings-and-member-experience-two-sides-of-the-same-coin/
https://www.mckinsey.com/industries/healthcare/our-insights/the-future-of-medicare-advantage
