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Provide the Ultimate Healthcare Customer Experience


Provide the Ultimate Healthcare Customer Experience: The Guide to Member Engagement Strategies

By: John Zimmerer, VP of Healthcare Marketing at Smart Communications

In a world where everyone is always on the go and as technology becomes smarter, faster and more intuitive, consumers increasingly prefer—and expect—digital-first experiences.

For highly regulated industries like healthcare, the stakes are even higher. Everyday customer interactions can be stressful, making the experience that health insurers provide at every touch point more important than ever. Recent benchmark data confirms this – with 81% of consumers indicating that communications are important to their overall experience with a company.

Unfortunately for healthcare payers, the industry lags in digital adoption, which has led to both internal inefficiencies and poor customer experience. As they interact with other non-healthcare industries that have set the customer experience bar high, healthcare members may begin looking to competitors to fulfill their needs. According to the Forrester Customer Experience Index, healthcare tracks well below the averages of most, ranking tenth out of the 13 U.S. industries analyzed.

In Provide the Ultimate Healthcare Customer Experience, we will walk through:

  • Key customer experience trends in healthcare
  • How healthcare payers can increase member engagement via cloud-based technology
  • The importance of omnichannel customer communications
  • Why Smart Communications offers the most complete platform on the market to support leading health insurers’ business strategies

Changing Customer Expectations and Regulations Drive Trends in Healthcare

The past few years have amplified the need for improved customer interactions. Globally, businesses have faced—and in many ways continue to endure—disruptions on multiple fronts. Many employers have moved their entire workforce to function as fully remote teams while continuing to navigate what the “next new normal” of work might look like. While all of these macro forces were influencing organizations to rethink how to do business, customer demands for digital-first experiences continued to increase.

Compounding to this digital transformation, the healthcare industry saw new regulations put in place, including:

  • Interoperability, which is “the ability of different information systems, devices and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner,” according to HIMSS
  • Price transparency, which allows healthcare patients to know the cost of a medical service before receiving it
  • Value-based care, where healthcare providers and hospitals are paid based on patient health outcomes
  • Shift to Medicare Advantage and ACA plans, providing individuals with more choices of health plans to purchase

As a result of these ever-changing market conditions, even the U.S. Federal Government has come to understand the importance of how much the customer experience matters to consumers when choosing a healthcare plan: for the 2023 plan year, member experience metrics make up the largest percentage (57%) of star ratings for Medicare Advantage plans.

Customer Experience Trends in Healthcare

On the bright side, insurers are beginning to realize the importance of making the healthcare customer experience a strategic priority. Recent findings include:

  • More focus on improving customer interactions. A Forrester report revealed that 15 out of the top 17 health insurers have experienced as much as a 5% year-over-year increase of their CX index scores – in large part due to these concentrated CX investments.
  • Higher investments in “total experience solutions.” These “consumer engagement” solutions improve the experience for both the employee and the member and are one of the top investment targets for health payers, according to Gartner.
  • Stagnant budgets. The same Gartner survey revealed that healthcare payers are seeing the lowest technology budget increases of any other industry. Health insurers therefore must invest wisely, strategically selecting key areas to improve that maximize the impact on the customer experience while minimizing disruption to both their members and their own organizations. 

So, how can health insurers set themselves up for success?

A cloud-based platform that optimizes the end-to-end healthcare customer experience provides the agility, flexibility and innovation that homegrown or legacy, on-premise systems cannot. Below, we will dive into the benefits of cloud for nearly every touch point in the member journey, plus how optimized member communications provide health payers with the competitive edge they’re seeking.

Healthcare Customer Experience supporting white paper: how a digital-first approach improves every step of the health insurance enrollment process

Convert One-way Customer Communications to Two-way Conversations

To positively impact the healthcare customer experience, payers need to focus their investments in transforming their member communications. Leading analyst firms like Forrester confirm this, with recent research indicating that one of the top drivers of delivering a better customer experience is related to improved member communications.

Forrester also cites consumer preferences like “respects me as a customer” and “effective website and mobile apps” as factors that positively impact health payers’ experience scores.

To do this, health insurers must keep member preference in mind – at every step of the experience. Members should be able to start and stop interactions across channels and devices without having to re-key information. Delivering communications based on channel preference is also a must, as 61% of consumers indicated that receiving messages on the wrong channel leads to frustration with a company. At the end of the day, effective member conversations require an efficient and accessible digital experience at every step of the process.

Benchmark report with data supporting the healthcare customer experience

Unfortunately, traditional ways of communicating with members aren’t as effective as they once were. So, as insurers rethink the healthcare customer experience, that means reimagining how members interact at every touch point. A big part of this is shifting from one-way, transactional communications to two-way, interactive conversations.

Delivering personalized, relevant and compliant conversations at scale can feel daunting, but the health insurers that invest in pure cloud solutions that are purpose-built to optimize member conversations will be set up for success. Cloud platforms, like the Conversation CloudTM, enable quick innovation, agility, scalability – and most importantly allow health insurers to evolve and scale as members expectations change over time.

RELATED READING | INFOGRAPHIC: Optimize Member Engagement at Every Point of the Health Insurance Journey

The Conversation CloudTM for Health Insurers

The Conversation CloudTM from Smart Communications empowers insurers to maximize their investments in the healthcare customer experience. Whether transforming a micro moment, such as a member-submitted claim form; to improving the access to and readability of critical communications like an Explanation of Benefits; or to orchestrate an entire customer journey such as a claim redetermination, look to the Smart Communications Conversation Cloud.

To better understand how the Conversation Cloud provides improves and transforms one-way communications into two-way, interactive conversations that positively impact the customer experience, this article focuses on four key areas where health insurers can enhance processes today:

  • Collect: Improve Data Gathering
  • Communicate: Increase Member Engagement with Content
  • Collaborate: Redefine Stakeholder Engagement
  • Coordinate: Reimagine the End-to-End Healthcare Customer Experience

Each section of this article provides examples and information to help insurers identify possible areas of investment, and in the process convert traditional communications into real-time, two-way conversations.

Healthcare Customer Experience supporting white paper: lower stress and costs for health payers, benefits administrators and enrollees

Collect: Improve Data Gathering 

As health insurance executives start to invest more heavily in digital, they want to ensure that their investments are making a difference.

In a survey of more than 100 health insurance and provider executives, respondents cited what their organizations are currently doing and where opportunities still exist for improvement. When examining these leading indicators that impact the overall strategy for digitization investments, it’s no wonder that “customer satisfaction” is at the top of the list.

Stats to help you decide to improve the healthcare experience Despite more priority and effort going into customer satisfaction, this ongoing goal is simultaneously an ongoing challenge. Several points of friction are still holding digital projects back from making consumers happy. As companies expand their investment footprint across online and offline touchpoints, removing those frustrations is even more essential.

The Impact of Forms Automation on the Healthcare Customer Experience

Forms are a great example of one important aspect of a larger member journey. At some point, insurers will need to collect personally identifiable and protected health information (PII and PHI, respectively) from members. Most of the time, it’s done via a form—like web “name, address, location” fields, a PDF document, or just simply a piece of paper.

RELATED READING: Optimize Digital Forms for COVID-19 Claims

One of the greatest points of friction for members is having to provide the same data—name, address, age, etc.—repeatedly within and across forms. Consumers have a simple request: ‘Show me you know me’. Healthcare companies most often already have the data through direct engagement, an employer, provider, insurer or relationships with third-party providers.

The first trick is in making the digital connection to existing data; the next is to use this data intelligently. That means using available information and logic to hide or show subsequent questions or input fields. It also means leveraging integrations with other third-party services (for example, autocompleting address information, scanning a barcode, validating bank or other account information, etc.) to significantly reduce customer effort and enhance the customer experience.


Static forms and similar tools can be cold and off-putting, therefore becoming a barrier to good data collection. To state it bluntly: customers just won’t fill them out. 


The Conversation Cloud allows health insurers to seamlessly collect customer information by transforming static forms-based processes into intelligent, conversational user experiences. SmartIQTM powers:

  • Adaptive interviews
  • Experience-driven interactions
  • Omni-device availability
  • Real-time data validation

How can insurers use forms automation to enhance the healthcare customer experience?

  • Submit/appeal a claim
  • Disclosure and consent forms
  • Prior authorization requests
  • Personal representative appointment

Interested in learning more? Check out four ways forms automation can enhance the healthcare member experience.

Communicate: Increase Engagement with Tailored, Omnichannel Content

Personalization is a prevailing tactic for healthcare’s move toward digital excellence, and it’s easy to see why: When consumers receive relevant (customized) content on the right channel at the right time, they’re more likely to act and respond.

The two most frequently used digital communications tactics in insurance and health organizations are personalized messaging and multiple format options to support delivery across channels.

Supporting omnichannel engagement can also help organizations make the transition to a self-service model. Customers overwhelmingly prefer a digital-first approach including apps or online portals that give them more autonomy.

RELATED READING: How enterprises can orchestrate effective omnichannel conversations, creating consistent, customer-driven experiences across channels.

As a result, healthcare members want options: mobile phones, tablets and wearables have created an “always-on” environment where they can get things done with a click of a button. Access to multiple channels—plus ever-increasing expectations—puts more pressure on customer communications.

Successful conversations require content that is readable and easy for the user to comprehend. To keep customers engaged throughout the process, communications must be tailored as much as possible to the individual reader. These all must happen in real-time and must be able to reference context from previous interactions.

Getting these conversations done correctly and with ease is crucial for successful interactions. As insurers are looking to align their business priorities with member expectations, it’s important to keep in mind that 60% of healthcare consumers recently surveyed indicated that improving relevance and personalization is a top priority.


Though these interactions are often mission critical, delivering personalized, real-time, contextual communications usually requires the creation and management of complex IT processes.


The Conversation Cloud empowers health insurers to create and deliver personalized, contextual and compliant communications across preferred channels to improve healthcare customer experience and deepen loyalty with:

  • Omnichannel approach for customer-preferred devices
  • Templates and reusable objects for consistency and compliance
  • Integrations with systems of record to pull in data for personalization
  • AI to improve readability and provide engagement insights

Ultimately health insurers can leverage these Communicate features across use cases, including:

  • Enrollment (ANOC, EOC, SBC, etc.)
  • Onboarding (ID card, provider/pharmacy directories, etc.)
  • Utilization (notifications/reminders, care management plans, etc.)
  • Claims (EOB, EOP, letters, etc.)

RELATED READING | Exploring CCM solutions? The Ultimate Guide to CCM Software provides a high-level overview of CCM software, poses questions to ask when selecting a vendor and more.

Collaborate: Change Stakeholder Engagement

Customer conversations sometimes require interacting with multiple stakeholders in a nonlinear process. Often, interactions occur outside the company altogether, e.g., with partners or regulators. Unfortunately, many businesses do not have a way for stakeholders to collaborate on business processes, which leads to a disjointed, frustrating customer or employee experience.

As a result, many fail to provide a holistic view of who made changes to critical documents, including what and when these changes were made. Requesting signatures or additional information from relevant parties can be difficult and these outdated processes can make sharing confidential information a security concern as well.


When multiple stakeholders are involved in a process, there is increased risk of error – or worse – compliance issues. Siloed systems and inefficient processes are also time consuming, open up room for version control issues and create poor member and employee experiences.


Not only can the Conversation Cloud help speed things up, but it can also make these multi-step processes easy and simple, which results in a more efficient and effective interaction for all parties involved.

Working in a secure, online environment eliminates version control issues and also helps ensure compliance standards are met. With the Conversation Cloud, health payers can negotiate and execute processes by negotiating and providing business-critical agreements across internal and external stakeholders using experience-driven workflow including:

  • Developing Plan Documents
  • Coordinating Plan Selection for Group Enrollment
  • Internal Review and Approval of Content or Communications
  • Regulator Review of Plan Documents
  • Negotiating Provider or Supplier Contracts

RELATED READING | Healthcare member communications are ripe for transformation – are you prepared?

Coordinate: Reimagine the End-to-End Healthcare Customer Experience

Health insurers must focus on orchestrated, omnichannel interactions that guide customers through critical processes and provide richer, deeper and more engaging experiences. By interacting with customers via their preferred channels, health payers can improve their overall experience and increase brand loyalty.

Smart Communications partnered with Forrester Research to examine the current state of customer experience in healthcare. This research found that although 63% of consumers want better-connected journey touchpoints to improve the member experience, 57% of health insurers are struggling with the ability to provide a seamless digital experience throughout a given customer journey. The research also found that payers provide poor personalization and that journeys involving forms are as troublesome for insurers as they are for members and partners:

By creating self-service workflows and connecting across organizational silos, insurers can help their customers get easy questions answered, or simple steps completed—such as benefit or claim inquiries—in as few (or preferably single) interactions as possible. Although this compression of customer journeys can cut out unnecessary steps or to remove delays, the underlying and greater emphasis is on removing friction that leads to a lowering of effort on the member’s part (i.e., the ease and effectiveness factors most favorably into the overall customer experience).

Members focus on moments that matter—the interactions and processes which are valuable or necessary to achieving a goal. As insurers are looking to make the healthcare customer experience more omnichannel, some key questions they should ask themselves include:

  • Are the required steps to achieve common goals clear?
  • Are we maximizing integrations to minimize customer effort?
  • Are there steps in critical customer journeys where customers are falling off or feeling frustrated?


The business (and the customer experience) can be negatively impacted when processes break down or a deadline passes.


Orchestrate interactions to optimize the customer experience across devices and channels with:

  • Facilitated two-way conversations
  • Failover from preferred to fallback channels
  • Analytics and insight into member engagement

Enterprises should invest in and prioritize technology solutions that evolve and scale as customer expectations change over time, delivering interactive, two-way conversations that encourage engagement and brand loyalty.

Healthcare customer experience supporting white paper: enhance the healthcare customer experience via improved member communications


Changing the Conversation in Healthcare

Health insurers can improve customer experience by removing friction and delivering personalized communications in real-time, via any channel, and at scale that are:

  • Customer-driven
  • Digital-first
  • Two-way
  • Relevant and contextual
  • Cloud-centric
  • Highly scalable
  • Omnichannel

At Smart Communications, we have the products, professional services and partner network to help insurers improve the healthcare customer experience, whether it’s to coordinate an entire member journey or to improve how customer information is collected. Contact us today to discuss where to begin.

Smart Communications for Healthcare


The Conversation Cloud is the only secure customer conversation management platform to have achieved an independent third-party validation of HIPAA, PCI-DSS, ISO and SOC compliance.

third party regulations in the healthcare industry


Our healthcare customers choose Smart Communications because they want to improve their customer experience, or they want to improve their operational efficiency. As a result, SMART customers see CX improvements reflected in higher NPS, CSAT and CX Index scores.

Additionally, SMART customers are seeing operational improvements driven by hard and soft cost savings by moving to a centralized cloud-native platform.

Payers & providers trust Smart Communications to enhance the healthcare customer experience


Smart Communications' partner ecosystem enables payers to enhance the healthcare customer experience