Promote wellness and convenience while controlling costs with Nuance

Change is a constant in the health care insurance industry. Insurance providers have to keep up with new regulations and economic shifts, as well as increasing consumer and employer demands and expectations.

Health care costs are growing in excess of overall inflation, while increases in medical service utilization are sustaining pressures on health insurance premiums. Historically, workers have been shielded from the true cost of health care, and as employers are exploring ways in which to mitigate health care expenses, costs are shifting to employees.

Interest in consumerism, intended to give consumers more financial and decision-making responsibility, is growing steadily. But can all consumers manage this responsibility? Consumer Driven Health Plans demand an increase in health literacy by members. Yet, according to a survey by the Institute of Medicine, nearly half of US adults (90 million people) have difficulty understanding and using health information.

Overall, consumer perspectives towards health plans have been improving, modestly. According to a 2006 Harris Interactive survey, public perceptions are still negative, but somewhat better than they used to be. However, 54 percent of consumers feel that managed care and health insurance companies are doing a bad job with customer service. Low customer satisfaction ratings impact your NCQA accreditation, your brand, and employers who select one plan over another. Driving high customer satisfaction with members truly does matter.

From an IT perspective, health insurance providers are subject to the constant scrutiny of federal, state and local legislative bodies. From HIPAA to HIE to HIT and CHI, compliance demands vast personnel and financial resources. Health care organizations and health plans are mandated to enable better information exchange with critical partners, as well as provide better tools to help members manage their health. Simply put, they must enable all participants in the health care ecosystem to interact.

So where does it all come together? Where is the convergence of business goals, IT directives and customer satisfaction? Member Services is the front line for customer satisfaction. If executed well, Member Services can drive competitive success in a very aggressive market.

Health plan providers are seeking to deliver information, education and transparency through each customer interaction. They want to do this using the most effective channel, whether inbound or outbound, landline or mobile.

Nuance, the leading provider of speech and imaging solutions, offers communication applications for the health care insurance industry that enable inbound services such as service coverage validation, provider participation status, eligibility status, claims’ inquiries, account activity and benefits information. Outbound services include appointment reminders, prescription reminders, formulary changes, satisfaction surveys and health status reminders.

Nuance health care insurance solutions are affordable and scalable, achieving a return on investment within months rather than years. Each solution supports the necessary regulations from HIPAA to SOX. Nuance solutions consistently deliver satisfaction across constituents, while helping plans promote wellness and control costs.