Do it themselves: by offering customer self-service, health-care can deliver the higher levels of service today's consumers demand, while also managing costs.

Key Points

* Not only does customer self-service help reduce costs and please customers, it has become a requirement for doing business in today's marketplace.

* Customer self-service gives customers direct control over the full range of account-related tasks, from finding information to executing transactions.

* Customers must be confident they can move from self-service to assisted service if necessary.

* CSS software should be integrated with related systems for consistent information across channels.

As renewal season nears, healthcare insurers find themselves trying to strike a delicate balance. While working to appeal to, and appease, an empowered base of customers and prospects, carriers must meet demands for higher levels of customer service while trying to address mounting concerns about rising health-care costs. Once again, insurers are faced with a seemingly impossible task--trying to balance customer expectations against operational cuts that can improve the bottom line.

Many carriers are deploying customer sell-service strategies to address these challenges. Customer self-service and related technologies enable insurance carriers to transform inefficient and unsatisfactory paper and phone-based communications into dynamic, Web-based interactions with their customers and partners. The result: improved operational efficiencies, drastically reduced customer-service costs and happier customers who get the support they want, whenever they want, on their own terms.

Not only does CSS help insurers reduce costs and please customers, it has literally become a requirement for doing business in today's marketplace. Organizations that do not have a comprehensive CSS offering risk leaving this renewal season, and future ones, with a losing record.

Crisis in Customer Care

Providing excellent customer service has never been more important. In a recent survey by Gartner, a top U.S. industry analyst firm, 68% of customers stated that they had left a supplier or service provider because they were upset with the poor treatment they had received--this despite the fact that it costs companies five-to-10 times more to acquire a new customer than to retain an existing one.

Fierce competitors also are actively enticing customers to switch providers, and unhappy customers are the easiest targets. Major inefficiencies, such as misapplied payments and lengthy dispute resolution processes, also drive up costs and breed customer dissatisfaction. For example, invoices and payments for group health-care insurance can have a 30% to 50% error/exception rate (including errors such as invoices not updated to reflect the latest employee rosters or payments applied to the wrong account or in the wrong amounts). Not only does this place stress on customer relationships, it also delays monthly premium payments, further stretching carriers' already high days-sales-outstanding numbers.

Many customer interactions today could be automated to cut down on these costly errors and delays while also increasing customer convenience and satisfaction. Business customers increasingly favor suppliers that empower them to control their information and processes on their own terms. This saves them from having to go through highly manual and inefficient processes for common activities such as updating account information, adjusting employee rosters, paying bills and downloading key information. Carriers that can simplify the customer's own processes can quickly encourage greater customer loyalty.

Gaining Control

Customer self-service gives customers direct control over the full range of account-related tasks, from finding information to executing transactions. It empowers customers to perform functions that might otherwise go through a call center or account manager/broker channel. CSS combines electronic presentment and payment, order management, knowledge management, personalization and application integration technologies to create an integrated, natural starting point for most customer-service issues.

Contact-center statistics provide critical insight into which issues generate the most inquiries from customers--and the costs associated with them. An analysis of health-care contact-center statistics shows that the vast majority of customer contacts--as high as 85%--involve a customer's account. These inquiries range from simple requests such as accessing the status of a claim or performing common administrative tasks such as requesting a new ID card to more complex processes such as enrollment and billing disputes. For this reason, a CSS solution must provide direct access to detailed account information often housed in disparate legacy information systems. Whether the customer is a member, an employer, a provider or a broker/agent, the self-service needs and customer demands are similar. These include the ability for the customer to do the following:

* Manage accounts--update employee rosters, access account details, review invoices or statements;

* Execute transactions--change coverage, execute payments, enroll for new services;

* Conduct research--compare plans, investigate problems, analyze activity; and

* Interact with the carrier--initiate disputes, report problems, escalate issues, receive alerts, view valuable information related to his or her account.

Carriers that deploy CSS capabilities are able to provide better customer service in a more efficient way. It costs insurers significantly less when customers can find the information they need or conduct transactions themselves than it does when a customer service representative assists them. Customers view self-service capabilities as a valuable service enhancement because it makes it easier and more efficient for them to do business with their insurer. Specifically, CSS helps carriers and their customers by:

* Giving customers a convenient starting point for all their account and customer care activities on the Web, anywhere, anytime;

* Reducing processing and handling time/costs associated with monthly billing, payments and disputes;

* Accelerating payments and reducing days sales outstanding;

* Providing insurers with better visibility into their own business, such as usage analysis, payment flow and process and problem status;

* Reducing dependence on the availability of a key account manager or knowledgeable customer service representative for routine questions and activities:

* Avoiding frustrating dead ends by passing along key information through intelligent, integrated escalation to assisted service if customers cannot resolve issues themselves.

Defining the Platform

An effective CSS platform organizes information and integrates relevant systems so that all account-related resources are collected in one place. This ensures that the solution will be the natural starting point for the customer's support needs and maximize the benefits for the customer and the carrier alike.

With a CSS platform, carriers can efficiently enable multiple applications that address the needs of their constituents. This modular platform serves as a foundation allowing for rapid deployment of multiple applications-such as explanation of benefits, enrollment, billing, claim status--while also creating a sophisticated infrastructure that minimizes redundancies and supports a longer-term vision.

Key Success Factors In Customer Self-Service

To be successful, an insurer's CSS solution must completely meet the contextual and usability needs of users and continue to evolve as those needs change. The requirements for success break down into five key areas:

1. Access to account data

Interactive access to detailed billing and account data is required to answer the most common customer queries and thereby establish the self-service solution as the first place to go for answers.

2. Customer-driven functionality and design based on actual top-10 inquiries

The most successful CSS implementations are based upon providing easy-to-understand capabilities to address customers' most common service needs, not merely to expose internal systems to customer access.

3. Managed transition between self-service and assisted-service

In order for the self-service channel to be the preferred starting point for customers, they need to have confidence that they will be able to move to assisted service if their questions are not answered. At the same time, this move needs to be managed carefully to avoid unintended support-cost consequences.

4. Integration with key systems and processes

As part of an overall service strategy, the CSS software should be integrated with related systems for consistent information across channels. Customer service representatives and marketers should be trained to reinforce the use of the CSS system in appropriate customer communications.

5. Continuous improvement

Customer service needs change constantly based on internal factors such as the introduction of new products, and external factors such as expansion to new types of customers. The CSS solution should be constantly revisited and enhanced to reflect actual usage patterns and changing needs. The importance of giving customers access to detailed account data is underscored by the fact that the majority of customer inquiries are account-related. Customers gain readily accessible information and capabilities that empower them to take control of their service needs, and the convenience of CSS applications reduces the cost of doing business for them. For insurers that deploy CSS, the cost savings are very real and clearly quantifiable.

Learn More

Harvard Pilgrim Health Care

A.M. Best Company # 68973 Distribution: Internal sales force, independent brokers

Blue Cross and Blue Shield of Minnesota 

A.M. Best Company # 60077 Distribution: Internal agents, independent agents, direct

For ratings and other financial strength information about these companies, visit www.ambest.com.

Visbal Daga is an industry solutions executive for health care at edocs Inc., a provider of customer self-service and e-billing software.