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Virtually Speaking

How Technology fits into the Health Insurance Exchange Picture

Posted by Next IT on Feb 21, 2013 1:32:41 PM


The idea behind insurance exchanges is simple. They’re supposed to help the uninsured find health coverage, and every state has received a mandate from the federal government to either build one out by January 2014 or get federal assistance in doing so.

I have personally gone through several of the states’ plans for building out their insurance exchange, and here’s what I've found:

The first idea that states propose is almost always to make it available via the web (online enrollment), which is a great idea since that’s where more and more people are doing business.  The big potential issue with an exchange’s website, though, is site usability. Insurance websites are not traditionally known for being user friendly; too much information tucked away in hard to find places makes for frustrated customers.  Further complicating the issue is that many of the people who need to buy insurance have a very limited understanding of even the most basic insurance concepts (which will end up driving expensive call-center traffic).  An insurance exchange website needs to be so simple that anyone with any level of insurance knowledge can navigate it with ease.

The second idea proffered by state plans is that each exchange should have a call center. Call centers may be necessary to deal with non-typical cases, however, a majority of users will start out online and would prefer to be able to complete their task in that channel.  Having to move from the web to the call center will frustrate consumers.  This is especially true if the consumer is trying to research or buy insurance after hours.  The exchange’s call centers will be open, on average, for a 10-12 hour shift, with most customers placing calls during several high-volume times. The result will be long hold times and call-center reps who are too strapped to answer all but the most basic questions. Reps will be able to quickly describe the different plans that are available to purchase, but they’ll be too busy to actually help educate the consumer about health insurance or to help them determine which plan is best for the caller.

What is great about the insurance exchange project is that the people tasked with implementing it are looking to innovate and improve their processes.  A great way to do this is looking into using an Intelligent Virtual Assistant (IVA).  An IVA will help improve both of the major traffic areas for the Insurance exchanges (the website and the call center).  It will be able to assist every user on any type of insurance question and help them navigate the website with ease.  To the benefit of the call center, the IVA will be able to answer the high volume questions that bog reps down allowing most consumers to complete their interactions online. This will free the call center reps to handle the most difficult questions that might truly require a human.

The exchanges are here to stay whether we like it or not.  It’s time to get on board, and an IVA is the way to stay ahead of the mountain of questions and ensure each consumer is not only able to get a plan but is able to get the best plan for them and to do it in a channel that is the least expensive for the State to support.

Topics: Customer service, Healthcare, Intelligent Virtual Assistants (IVA), User Experience