Anticipating patient distress in health insurance

Context & Objectives

Even a minor administrative process can become confusing in healthcare when concurrent with a medical condition, be it benign or severe. 

Therefore, a leading health insurer was committed to improving customer experience by identifying customers who might lose track of reimbursement procedures. 

There was a high suspicion that incomprehension caused many repeat inbound calls. Our project with the insurer aimed to identify patients at risk of getting lost and proactively reach out to patients before they asked for assistance.

Approach

We first carried out a segmentation based on interaction history (e-mail, calls, etc.), product holding, or socio-demographic indicators.

We then ran tests on the various identified segments, including

• Proactive outbound calls

• Dynamic case prioritization

All the tests ran against control groups to ensure we measured the right impact and not a less realistic "absolute" gain.

Results

After the implementation of the new case management rules in the organization, we measured

• A 20% drop in short term inbound contacts for prioritized cases (with the associated cost savings)

• Drastically improved customer satisfaction, measured (among others) in Net Promoter Score and Customer Effort Score.