Compared to other sectors, healthcare payers lag in customer experience (CX) and digital maturity
Payers aren’t meeting customer expectations
US consumers' net positive perception
Digital maturity level
Leaders
Advancers
Implementers
Beginners
Healthcare payers
Banking and finance
Retail
31%
56%
62%
3%
15%
20%
41%
Investment and asset managers
Commercial and investment banks
Insurance companies
Healthcare payers
Investing in CX pays off
Higher revenues
Reduced operating costs
Reduced medical costs
Win new accounts and members
Grow share of wallet with existing accounts and members
Increase retention
Lower call center costs through digital and AI enhancements
Builds trust, leading to better care management
How to delight customers
Determine the goal of your CX strategy and define metrics to track progress
Prioritize customer journey episodes with a higher likelihood to delight or frustrate
Redesign priority episodes to address your members’ pain points and needs
Increase omnichannel engagement with a focus on digital tools and experiences, supercharging them with generative AI
Notes: Net positive perception is the percentage of respondents who feel the industry does a “good job” with customer service minus the percentage of respondents who feel the industry does a “bad job”; digital maturity level based on company reported progress in achieving 24 digital transformation competencies across three focus areas (digitalized communication and client experiences, digitalized processes and work experiences, data analytics) and three underlying capabilities (organizational, strategic, technological); NPS® is a registered trademark of Bain & Company, Inc., NICE Systems, Inc. and Fred Reichheld
Sources: Bain US Consumer Survey, March 2024 (n=500); 2022 Broadridge Digital Transformation
and Next-Gen Technology Study (n=750); Consumer Assessment of Healthcare Providers and Systems; Medicare Advantage prescription drug plan; Bain analysis
Member experience now holds 40% weight in Medicare Advantage star ratings assessment
Across industries, satisfied customers purchase, on average, 2x as many products as unsatisfied ones
Member NPS® at churned commercial accounts are 6% to 9% lower than retained accounts, for small to midsize employers
Bain estimates that automation
can free up around 40% of agent capacity for more valuable activities
Only 52% of consumers trust payers to manage their overall care vs. 88% who trust primary care providers
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Good CX bolsters trust, resulting in higher engagement in care navigation and care management programs, ultimately lowering costs
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