Kaitlin Howard

By Kaitlin Howard

Kaitlin Howard is a researcher and writer producing insightful content across the healthcare revenue cycle. She has written and produced content for Zelis, Waystar, and Recondo Technology, as well as agencies. With a B.A. in English and Writing from University of Denver, Kaitlin stays current on market updates on claims management and healthcare payments, publishing a regular educational blog series on industry trends and Zelis offerings.

Members are in charge of the new market. Yet many organizations haven’t changed to reflect that.

The facts are simple, and so is the data:

  • Self-pay after insurance accounts for nearly 60% of patient bad debt in 2021, compared to 11 percent in 2018.
  • Self-pay after insurance collection rates dropped over 20 percentage points between 2020 and 2021 (that’s a decrease from 76% to 55% in just one year).
  • Out-of-pocket patient healthcare spending increased by 2% between 2013 and 2019 before declining due to the COVID-19 pandemic.

It’s time to make a move towards a member-centric model that walks the consumer all the way to billing and claims. But in order to deepen your member empowerment strategy and increase member satisfaction, you must increase overall trust.

Apparently, the buzzword of the year (yes, we’re looking at you price transparency) is on everyone’s lips for a reason.

A bit of background

Every brand relationship with a consumer is rooted in trust, which is typically earned through consistent delivery on consumer expectations. But with the digital transformation of society, consumerism has led to a role reversal.

There has been a fundamental shift in consumer behavior over the past decade. The arrival of COVID-19 has highlighted the importance of keeping members and their families and caregivers informed, connected, and in-charge of their own unique healthcare journey.

Healthcare isn’t one-size-fits-all. And the recent pandemic has blatantly illuminated that fact.

A 70-year-old life-long diabetic, a seemingly healthy 20-year-old, and a pregnant mother all have different needs within their healthcare journey.

Each consumer journey is a unique collection of specific questions posed to specific services that address a desire of need at a specific moment in the healthcare journey. But some commonalities unite all types of members, no matter their circumstances.

Everyone needs access to timely, accurate information and a better understanding of their available care options.

Members want greater control over their own care. They want (and need) the ability to take responsibility for the management of their own well-being. Meaning: members need to be empowered in order for our healthcare system to thrive.

Innovating new technologies

Many health plans are beginning to make concerted efforts to become advocates for their members and ensure access to high-quality, affordable healthcare. And building trust is a large component of eventually meeting the clinical, behavioral, and social needs of beneficiaries.

But to build trust, you need a vendor specific to the member experience.

Look for an organization that will place members at the heart of the experience optimization cycle, ensuring alignment between the consumer expectation and success of each particular experience.

Some vendors may be able to implement a comprehensive trust score, a multi-dimensional summary of consumer loyalty.

In something as complex as consumer experience, it’s difficult to take into account all the different business factors that govern consumer relationships. By aggregating a set of scored inputs into one larger score, you can begin to fully understand consumer satisfaction by considering a broader range of inputs that may offset potentially biased reactions that stem from single measures.

The four major components

Creating a comprehensive trust score starts by defining and aligning the use and value of each supporting measurement to ensure consistent use and gain clear alignment on the elements and situations of bias that may exclude score along the consumer journey.

Once you define your scores, they can be implemented to begin to generate data that will inevitably create a more sophisticated usage model. This creates a unified view of your current member satisfaction and allows you to create a member empowerment strategy that better guides consumer loyalty.

1. Net promoter score (NPS)

The NPS is the measure of a consumer’s willingness to recommend. By utilizing this score, your organization can more discretely measure the unique parts of each member’s experience to understand and combat more specific points of friction.

2. Voice of the consumer (VOC)

The VOC is the in-depth process of capturing consumer trust via expectations, preferences, and aversions. By integrating VOC data into consumer analytics, you can convert a typically qualitative measure into a quantified one, allowing you to add yet another dimension to the overarching member experience.

3. Lifetime value (LTV)

The LTW is a prediction of the net profit attributed to the entire future consumer relationship. When you integrate measures like LTV, your organization gains a better picture of what specific experiences directly affect renewal likelihood.

4. Consumer experience analytics (CEA)

CEA is an end-to-end data-driven view of the consumer experience via their interactions. By leveraging embedded experience analytics, you can continue to optimize each user experience to improve the overall quality of your interactions.

The wrap up

Meeting healthcare consumers where they are is key to the near-, mid-, and long-term success of healthcare organizations. A member’s first interaction with a health plan represents a pivotal moment for the latter to understand the former’s needs and provide options.

To learn more about how Zelis can help you increase your trust scores through our tools and services, connect with us.