In recent years, payers are expected to place a great deal of emphasis on the patient experience and care access. As members’ perceptions of their encounters with the healthcare system become more important, and the standards for health plan quality ratings are getting stricter, payers have to change the way they deliver experience.
Payers are crucial for guiding members and providers through a frequently confusing healthcare payment system. By adopting advanced AI-driven healthcare payer solutions, payers can navigate the complexities of changing reimbursement models, the growth of healthcare consumerism, and technological advancements.
AI-driven solutions enable payers to provide member experiences that increase engagement, influence health outcomes, and reduce costs.
Challenges in Providing Better Member Experience
Finding the best health plan solutions for members and other stakeholders is made easier by ratings and surveys, making the member experience more crucial than ever. However, payers who don’t prioritize advanced healthcare payer solutions and work with antiquated procedures and workflows face many challenges in ensuring this experience. Some of them include:
- Member Dissatisfaction: Outdated systems can lead to lengthy wait periods for help and significant work required to address problems and get inquiries answered. Members’ expectations for a simple, practical, and sympathetic relationship are not being met without PayerAI.
- Prolonged Wait Time: The switch to work-from-home arrangements and the surge in call levels have caused customers to wait a long time to speak with a representative.
- Inefficiencies in Operations: Agents are less able to assist the member with manual, repetitive chores like after-call work (ACW) without AI for healthcare payers. In order to complete workflows, agents frequently need to log into and access numerous systems, which affects both their productivity and other clients’ wait times.
- High Expenses for Claims: Overpayment of claims and recovery expenses can cost payers millions of dollars. Without AI-driven solutions, payers have to use unstructured audio data from discussions with patients and providers, which can increase the chances of overpayment.
4 Ways Payers Can Improve Member Experience
Improving member outcomes and cutting administrative expenses depend heavily on payers. There is a greater need than ever for creative methods to AI for healthcare payers as operational challenges continue to grow and healthcare demands rise.
To guarantee that members have the resources and information necessary to successfully navigate the healthcare system and get an exceptional experience, payers can follow several strategies. Some of them include:
1. Automating Care Accessibility
Members and providers frequently find authorizations to be a source of frustration. Care can be postponed for weeks due to the cumbersome authorization procedures. It affects the health of the patient as well as their perception of their payer and health plan.
Payers can increase their productivity and get rid of outdated prior authorization programs with the use of AI-assisted health plan solutions. PayerAI provides automation through pre-authorization workflows, which guarantee quicker processing and better patient care. Better member experiences and prompt care are the outcomes.
2. Using Several Channels for Communication
Payers need to treat member interaction like a consumer firm to improve the member experience. It is essential to use a variety of communication methods and update member contact information frequently. AI-driven solutions can help in this by following an “engagement first” strategy.
It helps payers to identify members’ preferred channel of communication and update their details automatically. The digital intake technology and scheduling further help to enhance the member experience and maximize access to care.
3. Raising Knowledge of Health Insurance
Even professionals find the healthcare system difficult to understand. Finding in-network doctors, comprehending health plan premiums, and evaluating their charges can be difficult and complicated for members. However, a patient’s overall health depends on their level of health insurance knowledge.
When payers leverage AI-based health plan solutions, they can better assist members in their healthcare journey. They can easily provide access to the information that members require regarding their healthcare requirements. Additionally, it improves their experience and guarantees that members receive care when required.
4. Enhancing the Efficiency of Member Call Centers
Despite the provided healthcare knowledge, members still require a contact to guide them for several needs. For a lot of people, calling healthcare plans and risk-bearing organizations is the initial step in their interaction.
PayerAI will make sure that members have someone to answer their urgent inquiries and give them care instructions. It assists payers with scheduling priorities and providing answers to basic queries automatically. This appropriate representation will contribute to better patient communication, health insurance literacy, and the overall member experience.
Bottom Line
Enhancing the member experience and access to care is essential for health plans and risk-bearing organizations to succeed in the long run. Based on their experience, they may rate and influence prospective members. Payers must make sure they give patients the resources they need, optimize their processes for quicker care, and enhance the communication experience if they want to stay competitive.
Two important strategies for payers to enhance the member experience are automation and outsourcing to a third party that leverages AI for healthcare payers. The care journey will be enhanced by implementing such AI-driven solutions that expedite previous authorizations and make it simple for members to get in touch with an informed representative. This also ensures that the payers will find it simpler to keep members and draw in new ones in the future.
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