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Why Member Services is the Key to Your Payer Strategy

By 01.21.22
Reading time: 4 minutes

On an episode of Curb Your Enthusiasm, the self-deprecating Larry David said, “You’re nothing without your health. Some people are nothing even with their health. I fall in that category, sometimes.” 

For many of your members, health may not be a top-of-mind concern, but without it, they have, well … nothing. 

People have a lot happening right now and they are over-extended across their personal and professional lives. The pandemic and its ramifications — the shift to remote work, a rise in unemployment, the Great Recession — have impacted everything from childcare to eldercare.

So, how can we help our members make the right choices and get the right care? By earning trust and winning the right to help them navigate their health journey. The key starting point for the payer/member relationship is having a thriving member services center, which gives payers the opportunity to connect with their members in a meaningful way. 

Why you need a strong member services foundation

Your member services team handles everything along the member continuum, from recommending healthcare providers to helping members get a new ID card or understand a recent claim, all with the ultimate goal to improve members’ health. Member services is where you can show your valued members that you care in a personalized and relevant way.

If done successfully, creating an optimal health insurance member experience can have significant impacts on your overall affordability and ability to win market share. Everybody wins because you’ll be helping your members achieve their health outcomes in the right care setting and at the right cost.

Why trust matters for member services

In any relationship, trust plays a massive part in building respect, security, and loyalty. The same is true in the relationship between payers and members, and is why trust should be the keystone of a payer strategy.

It takes enormous amounts of trust to gain influence over your members and make them see you as the right choice for them. Member adoption of healthcare providers tends to be low because trust has yet to be formed between the payer and the member. 

To build that meaningful relationship, payers need to earn the right to influence members and make them see that you are the one that should be advising on all their health needs. That is where member services truly shines, because those team members are the frontline trust-builders in the relationship. 

Why affordability matters for member services

Want to get the conversation going at your next dinner party? Bring up the topic of affordable health care — everyone will have an opinion on it! 

Affordability is one of the biggest problems in health insurance. It has been for a long time and will continue to be a contributing factor within member services into the future. 

Affordability refers to how payers help members get the right care, in the right setting, in the right way, and, especially, at the right price. Affordability for members is where many healthcare organizations are making their investment because that is essentially the starting point of a sound payer strategy. 

Affordability cannot exist without trust. Once payers have proven that members can trust them, they are more likely to open up their hearts, their minds, and their decision making to a payer’s influence. Members can then make the right choices and achieve better health outcomes but at a more affordable cost. 

The perfect pair to drive market share

Once a payer has achieved affordability in the market, it can provide them with the flexibility to then price their products competitively in the right markets and hopefully earn more member business. Payers often keep their prices low to win business, and this can cause swings in payer market share. Depending on the market it takes anywhere from 18 to 30 months for a member to be considered “profitable”. However, payers are often losing members in the first 12 months because they didn’t build trust with them. And without trust, affordability is negligible. 

Without profitable members, it is challenging for payers to grow and scale. Payers must take an active role in creating a seamless engagement experience across the entire member services journey. This relationship should be consistently nurtured and be beneficial at all stages, from acquisition and enrollment to renewal and retention.

How Silverline transforms your health insurance member experience

We’ve established that trust and affordability are the relationship building blocks for an effective payer strategy. But where should payers begin to foster these relationships with their members? 

It starts with having a 360-degree view of each and every member. This visibility provides insights to tailor your support to their individual needs. But member services teams often miss out on gaining a complete member view due to siloed systems that make it difficult to track member information and data. These inefficient workflows result in poor experiences for both your member services team and your members. 

Payers can maximize every member services interaction with an integrated technology solution that will ensure satisfaction, retention, and loyalty. Salesforce Health Cloud can help you create more productive and personalized relationships with your members. With Salesforce Health Cloud, payers can acquire, support, and engage members throughout their health journey with a streamlined engagement platform that connects people, data, and processes. You’ll get a complete view of each of your members with rich, contextual data for everything from current conditions to communication preferences.

Salesforce Health Cloud can transform typical member services interactions into opportunities to build meaningful relationships. And with those relationships comes the foundation of trust and affordability, leading to future payer growth and market share. Learn more about how we can help your organization elevate its member services.

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