Reduce the Volume of Calls, Appeals, and Grievances by Improving EOBs and Forms

By John Zimmerer, VP of Healthcare Marketing at Smart Communications 

Are you tired of the endless stream of calls flooding your call center, the constant barrage of appeals, and the frustrations of members with their healthcare claims? You're not alone.  

In this article, we'll explore how to tackle these challenges head-on with the use of leading forms automation and customer communications management solutions, leading to a smoother experience for both you and your members. 

Why Your Members Find Communications Difficult to Comprehend 

You've probably noticed that your members often struggle to comprehend how their claims are paid or what their responsibilities entail. Research from the Kaiser Family Foundation (KFF) highlights this issue, showing a clear gap in understanding among healthcare consumers. Additionally, new regulations like the No Surprises Act and CMS price transparency mandates further emphasize the need for clarity in healthcare communications. While there has been significant progress over the last few decades, health payers still fall short in providing communications in plain language that are both clear and jargon-free.  

Ultimately, this leads to a pressure cooker of confusion, stress, and unnecessary burden on both members and staff. In this collision of two forces—the lack of clarity and a lack of health literacy—the negative impact continues to grow. Some of these impacts include: 

• Increased appeals, including those won by the member
• Poor member loyalty and retention rates (more on that later) 
• Over-burdened call center staff due to high call volumes 

Member Loyalty and Retention Are Struggling

The landscape of healthcare is evolving, and with it, so are your challenges. Customer loyalty and retention are at stake, as evidenced by data from the Forrester CX Index. With over 43 Medicare Advantage plans to choose from, the competition adds more weight to the retention imperative facing health payers. High administration costs and increased churn rates are putting pressure on profitability.  

However, there's hope in the form of AI/ML technologies and advanced data visualization tools, which have the potential to revolutionize the way you communicate with your members. As I stated above, poor member loyalty is just one of the negative impacts of poor communication. Without the necessary transparency and clarity, it’s difficult for members to trust your organization. According to a J.D. Power survey, trust is a factor most highly correlated with Medicare Advantage plan renewals.  

Source: INNOVATE 2024, Internal research by Smart Communications 

Cloud-based CCM Software: A Modern Solution for Modern Problems

Your mindset and legacy toolset may be holding you back from embracing these transformative technologies. By failing to link operational metrics to customer experience and business outcomes, you're missing out on valuable opportunities for improvement. The breakthrough lies in leveraging AI/ML to enhance readability and interactive charting to improve data presentation, ultimately leading to greater transparency and understanding. 

Smart Communications understands the challenges you're facing and is uniquely positioned with the strategies and solutions to address them. We specialize in customer engagement and know how to leverage AI/ML and data visualization to improve customer comprehension and experience. By keeping you compliant with regulatory requirements while introducing CX enhancements, we can help you save costs, improve loyalty, and ultimately, drive profitability. 

If you're tasked with reducing call volume or appeals, or improving member retention, our solutions offer a clear path forward. By enhancing the readability and comprehension of key communications and providing self-service options, you can streamline processes, build trust, and transition members to more profitable plans. 

Conclusion 

We back up our claims with statistics, analyst accolades, customer testimonials, and recent wins with industry leaders. Our ROI calculator shows the tangible benefits of action, mitigating social and opportunity risks.  

By embracing innovative technologies and reimagining your approach to member communications, you can overcome the challenges of high call volumes, appeals, and grievances. With our expertise and tailored solutions, you'll not only save costs and improve efficiency but also enhance member satisfaction and loyalty. 

Ready to take the next step? Learn more about our Connected Claims platform or see a demo of our SmartIQ™ and SmartCOMM™ solutions in action. Contact us today to start streamlining your healthcare communications and reducing calls, appeals, and grievances. 

About the Author 
John Zimmerer is the Vice President of Vertical Marketing, Healthcare at Smart Communications, where he acts as a subject matter expert on the digital transformation of customer communications and data-centric, often form-based workflows. Most recently, John has been researching and writing about improving customer experience in healthcare and is regarded as a thought leader in this area. John has over 20 years of software product marketing experience. His areas of expertise include market research, analyst relations, public relations and digital marketing.