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Next enrollment season: Ready for a reset?

When consumers “miss” open enrollment and fail to elect healthcare benefits coverage, consequences can be dire. Families may be left out in the cold with no coverage whatsoever, a significant health and financial risk.
Payers can’t “miss” the enrollment season, either. It’s time for a reset.
Missteps can reverberate for years to come as consumers regale friends with details of a poor experience and warnings to avoid certain payers whose enrollment protocols were lacking. A company’s Star rating from Centers for Medicare & Medicaid is important but tells only part of the story. Many healthcare advocates in the contact center are trained to recognize CMS secret shoppers when they call about Medicare programs and workers can “game” the system by focusing on senior-centric concerns to impress CMS.
There’s a better way for payers to set themselves up in coming months for their best-ever annual and open enrollment season. First, it’s key to tune in to the mindset of consumers. Then, it becomes more clear which tools — many AI-enabled — and processes will enhance the experience for prospective and returning members.

Accept that consumers are savvier than ever

Consumers renewing or selecting healthcare benefits have never been better-informed about their choices. Their questions for healthcare advocates in the contact center are sharper and more complex: Is gender-affirming care covered? What about this prescription drug awaiting FDA approval? Will my homebound, disabled adult son qualify as a dependent? Does this plan comply with the No Surprises Act?
Their expectations have become more sophisticated. Consumers want access to digital tools to manage their healthcare, flexible spending accounts (FSAs), and health savings accounts (HSAs). They want options like telemedicine and self-service. They expect personalization, convenience, and greater visibility into what healthcare services and procedures actually cost.
The industry has not sufficiently embraced the online tools consumers want and concerns have never been so acute, according to J.P. Morgan’s Trends in Healthcare Payments 14th annual report:

  • 75% of consumers want to pay medical bills online
  • 37% of payers are challenged by high dollar claims
  • 59% of consumers are comfortable with AI in their healthcare experience
  • 73% of consumers say healthcare is not meeting their needs; more than 50% say that’s due to cost
  • 1 in 3 consumers have medical debt; 2 in 5 consumers delayed or skipped care due to cost 

Some 66% of payers surveyed said the volume of calls about payment questions and member confusion is a top challenge for their organizations.

The next enrollment season is virtually … upon us

Now is the time to begin preparations for the upcoming 2025 enrollment season. It can start with a basic assessment of how the most recent cycle performed and which process and technology changes could make the next enrollment season even better. Consider asking:

  • How are my attrition rates trending?
  • Did sales conversion rates exceed last year’s?
  • Am I satisfied with speed-to-proficiency?
  • When is the last time training was updated or enhanced?
  • Is my member acquisition strategy clearly defined? 

Payers working with customer experience experts gain access to the most innovative, proven technology such as solutions piloted in TTEC’s AI Center of Excellence and strategies via TTEC’s Member Acquisition Center of Excellence. Based on our work with leading payers, here are five best-in-class solutions that improve conversion and attrition:
1. Coaching and feedback bots: Interactive AI bots for member acquisition incorporate top call drivers so healthcare advocates in the contact center can practice newly acquired skills in a simulated, role-playing setting before advancing to live calls with members and prospective members.

2. Objection bots: This new breed of AI-enhanced bot is programmed specifically around common reasons prospects fail to convert. When healthcare associates practice and get comfortable handling member resistance, they are better able to handle calls with respect, efficiency, and empathy.

3. Asynchronous learning: These flexible learning modules are delivered digitally, enabling employees to train on their own schedules, remote or on-site, when outside distractions are minimal and potential to retain course material is at its best.

4. Customization: Best practices — those market-defining strategies deployed by top-performing payers — are the ones to consider adopting as your own. With the help of experts, these solutions can be customized to a payer’s unique operating environment, goals, and objectives.

5. Leader certification: Consider proprietary certification programs offered by TTEC and others that enhance overall performance and earn top NPS scores. 

Time for a reset

For payers, particularly those selling Medicare Advantage plans, the need to contain costs is paramount. According to McKinsey, it’s time for a reset. Utilization rates, regulatory changes, attrition, even changes in how CMS Star ratings are awarded, oblige payers to refine their strategies for the next enrollment season. Rinse and repeat won’t get the job done.