How Back-Office Automation Can Transform the Payer Customer Experience

Back-office automation is a core component of payer digital transformation, affecting much more than just the bottom line. Patient-centric operational workflows save money, improve quality and, importantly, keep consumers healthy.

Payers increasingly recognize the upside of accelerated digital transformation, and customer experience is emerging as a top priority to transform. According to a recent Accenture report that surveyed 150 payer executives, 40% of payer executives feel “improving customer experience” is a top challenge, and 33% feel the same way about “increasing productivity/decreasing administrative costs.” These two challenges are directly related, and the same set of digital tools and strategies can help solve for both.

A positive customer experience for members is multifaceted. Consumers interact with payers in a variety of ways: signing up and joining, selecting providers, receiving care, managing their health and finances, addressing questions or problems, and renewing coverage. Back-office functions such as prior-authorization, claims processing, up-to-date provider directories, co-pays, deductibles and explanations of benefits all contribute heavily to the customer experience across those touch points. When customers have a negative experience along any of those touch-points, they become increasingly at risk of not renewing.

Key stakeholders for payers include not just members but also the providers who treat them. Effective and efficient value-based contracting, speed of reimbursement and easy access to claims data contribute to provider satisfaction and effectiveness. Provider network engagement allows providers to more efficiently and effectively treat patients. When payers and providers are aligned in their incentives and share the insights to perform against those incentives, patients benefit both clinically and financially.

Unfortunately, back-office processes have historically created friction with both members and providers. Digital transformation is rapidly eliminating this friction with value-based digital tools and platforms that can automate key business and clinical processes. With tools that allow payers and providers to “share the math” of clinical measurement and reimbursement models, a transparent relationship is fostered that empowers providers to deliver better care to their patients.

“The back office is now being expected to power the front office.”

—Accenture, 2019

As another example, today’s prior-authorization process requires multiple staff members (clinical and administrative), phone calls and faxes, and can leave members waiting sometimes days or weeks for the treatment they need. This traditional approach has a negative impact on member satisfaction and costs providers billions of dollars annually. By using digital tools to create patient-centric operational workflows, payers can automate the prior-authorization workflow, using digital guidelines and electronic pathways to identify if the provider is compliant, and automatically approve or deny a treatment request or offer an alternative as appropriate. Additionally, the payer and provider staff who previously manually processed prior-authorizations can be reassigned to higher value tasks.

Digital transformation is driven by a variety of goals, including decreasing costs, improving quality and increasing customer satisfaction. These drivers aren’t mutually exclusive, and can complement each other, as evidenced by the impact of back-office automation on the customer experience. Digitization and automation is the future of healthcare, and payers are embracing this transformation to enhance the experience of those who matter most: the patients.

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