(Edited July 12, 2022)

The impact of technology, Internet of things (IoT), medicare regulations and inevitable cultural shift from cost to consumers in today’s healthcare environment have brought more purchasing power to individuals, when it comes to health insurance.

To acquire and retain this newly empowered consumer base, which has access to countless consumer-first health plans and tools that allow consumers to compare the cost, benefits, deductible and out-of-pocket maximum, health care payors must react and reorganize their business models. They require a much higher level of technological adaptability and operational efficiency not only to overcome the challenges, but to provide the new and existing members with a superior omni-channel, contextual and personalized experience while managing administrative costs and challenges.

According to PwC, if healthcare payors want to succeed in today’s competitive environment, they need to meet the strong demand for more consumer-centered digital experiences that help members control their spending and improve their own health, especially when global healthcare spending is on an “unsustainably high” upward trajectory right now. This puts tremendous pressure on payors to develop an engaging digital experience for members to produce high-value outcomes with minimum resources.

According to the 2019 annual North Highland Beacon Report, 84 percent of leaders among health payors indicate that delivering exceptional customer experience is their top strategic priority, but there is a disconnect with the majority not feeling prepared to address the priority


Eye opening facts about Member Engagement & Member/Payor Experience

  • 65% of consumers have cut ties with a brand over a single poor customer service experience.
  • According to studies, typical insurer’s customer communications are 90 to 99 percent sales-focused and only 1 to 10 percent service-focused.
  • Satisfied customers are 80 percent more likely to renew their policies than unsatisfied customers.
  • More than 90 percent of insurers worldwide do not communicate with their customers even once a year.
  • Research by Prophet found that 81 percent of consumers are unsatisfied with their health care experience, and the less they interact with the system, the happier they are.
  • 72% of consumers say their engagement experience with both providers and health plans hasn’t improved—or has worsened—over the last two years.


Major challenges

Shifting relationships – The payor-provider relationship is changing. Instead of the traditional model of simply reimbursing services rendered, today’s payors and providers are moving towards financial collaboration and risk sharing, such as incentivizing providers based on quality, outcomes, and costs. This completely redefines their relationship and it is yet to become clear how healthcare payors can offer their healthcare provider partners a more customer-like experience.

Communication barriers – There are many daily touchpoints where payors and providers interact with each other! Any friction in communication, in terms of inconsistent or conflicting data input and hesitation to share information real time, is a barrier in creating a data-driven payor solution, indirectly impacting the members’ experience.

Growing financial burden and expectations – Costs of healthcare continue to rise and more of the financial burden of healthcare is placed on the shoulders of consumers, either directly or indirectly. As a result, they expect healthcare payors to connect with them on a personal level, provide more information and better tools to find the right coverage and help them to save money.

Lack of control – Most consumers come with an employer-based health insurance model and this means that most end users have little to no say in their insurance plan. Actions by health insurance companies certainly add to this discomfort and consumers in general are frustrated by their overall experience with their health insurer.

Lack of trust and personal touch – Consumers want to be treated like people, not policy numbers! They want their health insurer to connect with them as a trusted, personal advisor who can educate, but not overwhelm them with information and choices. The only way to gain trust is to understand individual consumers.

The need of the hour is a unified platform that can enable payors to build and nurture continuous, meaningful engagement with the members, providing contextual, emotionally connected healthcare support throughout their healthcare journey. Here is where Acqueon comes in.

How Acqueon Supports Healthcare Payors with Proactive Member Engagement

Aqueon’s AI-powered Conversational Engagement Platform enables healthcare payors to acquire and retain today’s tech-savvy consumer base with a highly personalized, frictionless healthcare experience. Our omni-channel, inbound/outbound engagement platform offers a better payor participation in their healthcare journey, ensuring significant cost-efficiency, transparency and better care from provider networks. We help them create stronger and longer-lasting relationships with members and healthcare providers alike. Healthcare payors can now be a customer-centric organization that provides high-quality customer experience with minimal resources and low operational costs.

  • Multimodal campaigns with email/SMS trigger and auto scheduling for preemptive care communication and wellness updates
  • Personalized outreaches based on preferred channel and time/day of every contact.
  • Call-back management to avoid long queues that significantly reduce patient frustration
  • Frictionless pre-registration hospital processes, easy claim filling and claim status updates with minimum agent intervention
  • Automated updates on reimbursement payment updates, or plan enrollment deadlines.
  • Increased contact rates by orchestrating and executing highly targeted and personalized outbound communications campaigns
  • Full customer journey visualization for the agents with context and recommendations for next-best action
  • Ability to automatically routing incoming calls to the agent(s) most suited to handle the member’s needs.
  • Centralized list management for inbound, outbound and blended contacts
  • Integrated contact monitoring and digital voice/screen recording and real-time analytics
  • Advanced options such as appointment setting, automated messaging, virtual agents etc.
  • Regulatory Compliance for DNC and consumer privacy and protection legislation; in-built data privacy and compliance tools.


Acqueon is on a mission to transform the future of member and patient engagement

Acqueon is committed to our bold vision; to help patient and customer-obsessed organizations fuel growth through powerful, trusted conversations. Delivering exceptional, , 5-star, end-to end member and patient experiences help Payors and Providers stand apart from a sea of competitors all vying for attention. With omnichannel (voice + digital) outbound campaign management and campaign orchestration, Acqueon gives Healthcare Payors and Medical Providers a 360-degree view of the patient/member relationship and provide delightful and personalized experiences across all communication/interaction channels.


Member & Patient Engagement Capabilities Modern Payors Need to Offer

Offer the right customer experience – anytime, anywhere

With Acqueon’s built-in AI model, agents get to deliver the right message at the right time to the right customers. When the dialer connects the agents with a member, the agents will have contextual understanding of the member’s full journey right at their fingertips. This helps your agents become more engaging and conversational with your members in order to maximize the potential of every conversation, improving the conversion and retention rates.

Take the lead on every agent-member interaction

Integrated with the customer database and CRM, Acqueon solutions can enable you to improve your lead conversation ratio based on time zones. You will run more successful outbound campaigns by targeting select subsets of your membership and complying with their unique contact preferences. You can also capture queries and any other customer-facing information through multiple channels while tracking response rates and automatically updating the records. Intelligent call routing increases agent productivity and member satisfaction by automatically routing incoming calls to the agent(s) most suited to handle the member’s needs.

Risk mitigation and proactive healthcare

Acqueon pinpoints members with serious health risks and assign them to targeted campaigns. It then determines the members’ preferred channel/time/date to contact them. It can also automatically send doctor’s appointment reminders, prescription refill notifications and so on to ensure member compliance with healthcare provider treatment plans. This keeps your members healthier and helps mitigate preventable health issues and any associated care costs.

Preventive care and health updates

Our dynamic campaign orchestration capabilities allow your member interaction teams to send targeted communications to specific individuals to help them improve their health. You can create multimodal campaigns with email/SMS trigger for preemptive care communication, wellness updates and lifestyle tips to at-risk patients like someone with diabetes or blood pressure. For high blood pressure members, Acqueon can automatically send articles on healthy eating habits. With senior members, for instance, the system can send information on proper techniques on walking for exercise.

Harness outbound and self-service capabilities

Acqueon’s outbound messaging and text-to-speech tools guide agents to engage members whenever and wherever they are needed the most. Whether initiating requests or delivering confirmations, you can also transfer the calls to agents or leave automated messages with call-back options. Acqueon ensures frictionless hospital processes, easy claim filling, claim verification, reimbursements, enrollments, timely payments and other clinical support with minimum agent intervention.

Unify organization-wide communication across sites

No matter the size or type, every healthcare business thrives on operational efficiency. Acqueon helps you to create a unified communication ecosystem for transformational inside-out experiences. The centralized ecosystem maintains a highly refined and flexible calling list that reflects up-to-date member status, policy and payment details etc. Whether inbound or outbound communication, our next-generation solutions ensure smooth interoperability that leads to effortless patient and agent experiences. Our asynchronous and real-time tools allow you to manage multiple sites from a centralized location.

Serve with world-class regulatory compliance

Acqueon ensures an ongoing regulatory compliance to TCPA, Do Not Call List, GDPR and industry guidelines. It helps banks keep track of these restrictions so the dialer and the agents avoid unnecessary infractions. Mobile phone numbers are automatically removed from calling lists when they appear on the Do Not Call List and outbound dialing automatically restricted to approved calling hours.