The year 2020 has been described with words such as lost, chaotic, surreal, relentless and exhausting. The onset of the COVID-19 pandemic forced companies to think and work differently. Gone was the luxury of months of planning and preparation. The drive to innovation prevailed in a more timely manner than ever experienced before. 

So what is to be said for an industry that historically does not move swiftly, but is much more methodical and often behind the technology curve? And how does this impact the health insurance Payer? Payers now face evolving trends that require a nimble, thoughtful approach to the way they tend to their members. 

Health insurance industry trends in 2021

These emerging and evolving trends are sure to impact how health insurance companies, particularly in the United States, think about their health systems. Whether providing long-term, managed care or helping members better understand their prescription drug options — Payers should focus on the following with every member interaction.

1. Right care, right time

In-person provider visits are on an incline, however, telehealth is here to stay. What began as a stop gap measure to improve access to care during the pandemic, Payers are now looking to expand telehealth services. 

As Payers navigate this expansion of telehealth services, they must also address the concerns that have surfaced regarding telehealth: quality of care, over-utilization, increased healthcare spending, privacy concerns, fraud, and abuse. 

While these concerns can occur in many facets of healthcare, telehealth provides an opportunity for provider and patient interaction that can be leveraged between in-person visits. This allows providers to continue the momentum of care. 

2. Exceptional customer service, no exceptions

Members expect the same level of service from their health insurance payer as they do from other service organizations. 

Years ago, payers had patients calling into member services and going through an Interactive Voice Response (IVR) to get their questions answered. Fast forward to 2021, and we have a society that expects instant access and communication options through email, text, and video chat. 

When members call into customer service, they expect their representative will have access to all of their information, and the historical data from past inquiries. Every interaction with that member should be available to the customer service agent, along with any information surrounding their social determinants of health. Members want to be active participants in their health care and coordination. 

Payers must find alternative ways to meet the members’ needs while managing technology that may be antiquated and disparate from other internal systems. They must also provide their service agents with the tools necessary to make every interaction with a member a positive experience.

3. Analytics abound

Analytics tools have escalated to the forefront of population health.

Health insurance Payers have been known to have access to a lot of data without using this data to their advantage. Payers now see the value of predictive analytics to help improve population health, and reduce the burden to our healthcare system. 

Analytic tools can provide powerful information such as: insight for prevention of unnecessary emergency room visits, improved patient’s treatment and care experience, guiding a member through their care management program and prediction of deadly disease. 

The challenge Payers face is in identifying the necessary tools to harness all of this insightful data in a manner that is digestible. Their AI tools need to identify trends not only from a clinical perspective, but also within their sales and operations divisions. 

How Silverline can help

At Silverline, we have the payer expertise to provide solutions to Payers facing the above challenges. We understand these challenges and have extensive experience solving these challenges for our clients. We use the full suite of Salesforce products to assist our clients with:

• maximizing their care plans for their members
• creating member services solutions that deliver immediate value for member populations
• gathering unique, actionable insights from the data captured by Payers

Silverline offers Payers a blueprint for success in which every functional area within your organization can benefit from our industry knowledge, best practices, and thoughtful consultation. Learn more about how we can help your organization.