We all have that favorite streaming series we’ve sat down and binged for hours. And as soon as the player asks if you want to go to the next episode, you quickly say, ‘yes, more please.’ Usually it’s because you are enjoying the show and anticipate what will happen next will be even better.  

The great experience that viewers have with a series is very similar to what healthcare payers want to achieve with their members. Payers want members to like what they see, have a good experience, stay awhile, and continue coming back for more. 

Payers are providing an omni-channel approach to servicing a member. It’s not just about giving good service around the initial shop and enrollment process on the portal, but extending that positive member experience to anything and everything that has to do with the member.

Member retention is a critical element of a payer’s strategy, yet many payers are not maximizing their technology around it to its full potential. By leveraging the cognitive capabilities of Salesforce, payers can improve member engagement, increase member satisfaction, and continue a long-term, rewarding member relationship.

Transforming to a member access center

Payers must address the clinical and non-clinical aspects of the member relationship. The clinical portion includes care management and coordination, and the non-clinical includes shop and enroll, plan management, and renewals. 

With a single, unified digital platform, payers can bring together both clinical and non-clinical elements and gain a 360-degree view of each member. The solution transforms the traditional contact center into a member access center that is better equipped to improve member experiences and member outcomes. A member access center can uniquely provide:

• More first call resolution: Integrated, in-depth information on each member plus market data gives agents access to the knowledge they need to help members immediately.
• Reduction in call volume: Self-service intelligent agents utilize cutting-edge technology to reduce calls leading to fewer costs and resources.
• Enhanced member journey: An omni-channel approach and a self-service portal allow members to connect the way they want to connect.
• Fewer platform inefficiencies: The entire member journey is available on one platform without the issues of disparate systems and siloed data. 

By making the pivot to a member access center, healthcare payers are finding success with cost-effective technologies that help support members’ rising expectations for superior service. Typical outcomes include:

• 15% increase in member satisfaction: Simplifying a member’s healthcare journey with personalized information across all channels and devices improves the overall experience.
• 10% increase in enhanced revenue generation: Empowering contact center agents with selling skills and techniques enables them to cross-sell and up-sell products in addition to handling a service call efficiently.
• 40% decrease in access center operations costs: Re-engineering the agent role, automating repetitive labor, increasing call deflection, and reducing search and hold times all result in lower costs.
• 10% improvement in efficiency and effectiveness: Payers can ultimately gain member satisfaction and retention by reducing wait times and delivering faster and more accurate responses.

Salesforce Industries delivers cognitive care for payers

The foundation for all member services begins with an agent workflow-centric member access center that is built to gain and retain members. The service center’s underlying technology is built on Salesforce Industries and powered by intelligent workflows that are complemented by external industry data. Payers can enhance relationships with member-centered engagement driven by intelligent and personalized interactions by having a single-unified digital healthcare platform.

According to a survey from Tidio, about 53% of respondents find that waiting too long for replies is the most frustrating part of interacting with businesses. If the alternative were to wait 15 minutes for an answer, 62% of consumers would rather talk to a chatbot than a human agent. 

That’s why the main emphasis of the member access center is on having the Intelligent Virtual Agent. Live Agents are still available to help members with questions or concerns that require human interaction, but the Intelligent Virtual Agent provides self-service on the payer’s portal. The Salesforce feature can quickly address a member’s inquiries and respond with the relevant information – leading to less wait time and more satisfaction. 

Suppose the member does get transferred to a Live Agent. In that case, the Salesforce Agent Assist feature is used for automatic case assignment and escalation to the appropriate team based on the member inquiry. Agent Assist also provides member access center agents with the additional information about the member that is necessary for handling inquiries faster and with more accurate resolution. 

Salesforce Agent Assist leverages Salesforce CRM Analytics (formerly Einstein Analytics) to allow agents to retrieve critical insights and visualize key metrics about the caller. The CRM Analytics Next Best Action solution uses flows, strategies, and the Recommendation object to recommend actions to agents. Agents don’t need to “swivel chair” between applications and can pull the member’s information that is related to the conversation right within the Salesforce agent console.   

Having member insights and analytics at their fingertips also gives agents the opportunity to cross-sell and up-sell – to the benefit of both the payer and the member. For example, the agent may notice that the member doesn’t have dental insurance and can share the cost to add it to their plan. Upselling provides the payer with additional revenue, and the member is satisfied to receive a valuable benefit for their care management.

Silverline helps with member retention

By taking advantage of every member access center interaction, payers can ensure member satisfaction, retention, and brand loyalty over the life of the plan. Silverline provides payers with the Salesforce Industries tools necessary to enable services teams to deliver these rewarding experiences for members. 

The Silverline team leverages insight acquired through 10+ years in the business and thousands of engagements, along with real-world expertise gained across the healthcare industry. Silverline is here to guide you through every phase of your Salesforce journey, from strategy and implementation to managed services. Learn how we can help you enhance your member access center.