Tech-Driven Payer Strategies to Enhance Member Experiences, Control Costs

By Jill Warren

The healthcare payer landscape is volatile, but two challenges have remained consistent over the years: improving the member experience and lowering the cost of care. 

Payers continually grapple with balancing cost containment and delivering a superior member experience. As healthcare costs continue to rise, payers are identifying and turning to innovative technologies, specifically artificial intelligence (AI), to streamline operations, personalize interactions, and enhance member satisfaction while managing financial pressures.

There’s one tactic that solves for both issues: omnichannel communications.

Create Exceptional Member Experiences

AI-driven member engagement platforms are revolutionizing communication and support. These platforms leverage chatbots, GenAI, and Agentic AI to provide 24/7 assistance for member inquiries, addressing frequent questions about benefits, eligibility, and claims. “Healthcare organizations should prioritize digital interfaces for patient interactions and data collection, aligning with the growing consumer preference for seamless digital experiences,” according to the 2024 Global Benchmark Report: The State of Healthcare Customer Experience.

For example, automated claims processing—when done right can dramatically and positively affect member sentiment—is one key area for technological integration. Traditional claims processing is notoriously time-consuming and prone to errors, leading to delays and frustration for members and providers. By implementing AI-powered systems, payers can automate the verification and processing of claims, significantly reducing administrative overhead and accelerating reimbursement. This not only minimizes costs but also enhances member satisfaction by ensuring faster and more accurate claims resolution.

In addition, personalized, omni-channel communication—phone, text, online chat, and a member portal—is crucial for driving member engagement, satisfaction, and the quality of care.

Tech-enabled platforms allow payers to tailor communication based on individual member preferences and needs. This can include emailing personalized educational materials, texting targeted health alerts, and providing customized recommendations for preventive care. By delivering relevant and timely information, payers can empower members to take control of their health and make informed decisions.

“Engaging members through digital tools can improve care coordination, reduce costs, and enhance patient (member) satisfaction, but these initiatives must be balanced with efforts to ensure equitable access to technology,” according to A&M.

By keeping members engaged through multiple communication modalities, they become more informed about their health and enjoy enhanced health outcomes.

The Importance of Primary Care

For patients, a dedicated primary care provider fosters continuity, convenience, and trust. This relationship enables personalized care, facilitates early disease detection, and simplifies appointment scheduling compared to episodic emergency or urgent care visits. The established trust also encourages open communication, potentially improving health outcomes and providing support during serious illness. A full 85% of healthcare customers in the US say communications are very important or somewhat important to their overall experience, according to the 2024 Global Benchmark Report: The State of Healthcare Customer Experience.

For payers, prioritizing patient engagement with multi-modal communications focusing on the importance of primary care can improve health outcomes and reduce costs. Wellness strategies and chronic disease prevention lead to lower healthcare expenditures, increased member and provider satisfaction, and better overall population health. All of which can be supported through consistent outreach.

Digital Tools for the Win

Using digital tools such as mobile apps, email, texts, and member portals provides members with easy access to plan-related information, enabling them to manage their benefits, understand explanation of benefits documents, and monitor the status of claims. 

Predictive analytics is another powerful tool that payers are utilizing to address member needs and control costs. By analyzing vast datasets, including claims data, medical records, and demographic information, AI algorithms can identify at-risk populations and predict potential health issues. This allows payers to implement targeted interventions, such as personalized wellness programs and preventive care initiatives, reducing the likelihood of costly hospitalizations and improving overall health outcomes.

Instant access to information eliminates the need for lengthy phone calls and reduces wait times, improving member convenience and satisfaction. For example, chatbots powered by natural language processing (NLP) can understand and respond to complex queries, offering personalized guidance and support. Increased accessibility and convenience enhance member engagement and satisfaction.

Innovative healthcare payers are leveraging technology to:

• Automate administrative processes: Reducing costs and improving efficiency.
• Provide around-the-clock member support: Enhancing convenience, satisfaction, and retention.
• Predict and prevent health issues: Reducing costly hospitalizations and emergency department visits.
• Personalize communication and engagement: Empowering members to manage their health and creating exceptional experiences.
• Increase digital access: Streamlining member interactions.

When payers embrace tech-driven strategies it makes it easier to navigate the cost pressure challenges while delivering exceptional member experiences, fostering loyalty, and improving health outcomes.

This article originally appeared in Healthcare Business News.