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How Legacy Systems are Hindering the Healthcare Insurance Experience

Legacy systems are the anchor that’s preventing healthcare insurance executives from moving forward. Here’s why removing those systems creates a better member experience.

A few weeks ago, I spoke on a panel of industry experts on Insurtech Insights’ webinar, “Healthy Customers = Healthy Insurer.” During the session, we discussed the future of insurance, including how the industry has changed as a result of the pandemic, generational preferences, and the technology that will help insurers improve the customer experience in the years to come.

Empathy is one of the major themes coming out of the pandemic. As my fellow panelist, Somesh Chandra, chief health officer at AXA, put it, “Empathy is important in terms of what we do. If you don’t provide [the kind of service] customers are looking for and taking for granted now, you’re out of business. You have to be a partner in the customer journey.”

To his point, as I mentioned during the webinar, working from home over the past year-plus has leveled the empathy playing field for everyone — from executives to customer service reps — who all have been working with noise and distractions all around them, from kids and barking dogs to the UPS delivery guy coming at exactly the wrong time. That empathy that everyone now feels has opened an opportunity for change. Digital roadmaps for executives are different now than they were a year ago, and that creates an opportunity for digital transformation.

Empathy vs. Healthcare Technology and Jargon

However, legacy systems are the anchor that’s preventing executives from moving forward. Another obstacle to digital transformation and an improved customer experience, also tied to empathy, is the jargon that complicates the member experience for health insurance. When I was at Blue Cross-Blue Shield, during our monthly executive team calls, we listened to an hour’s worth of member calls. The question from members was always, “Am I covered?” Whatever it was, from a doctor or hospital visit, to an accident, that anxiety was real. When the response from the insurance company includes words like HMO, PPO, medically necessary, balance billing, reasonable and customary, those words mean nothing to someone on the other end of the line who’s worried about whether they’re going to be able pay their bills out of pocket.

That translation of nomenclature is something we’ve been struggling with since the dawn of healthcare. Leveling the playing field with digitalization and consumerism could help crack that code. As I mentioned during the webinar, it’s unacceptable for someone sitting at their kitchen table having to have discussions about what’s reasonable and customary and medically necessary. It doesn’t work, it’s never worked, and it causes so much frustration for members. Health insurance CIOs and CTOs need to think about their entire ecosystem and plug into vendors that are providing real benefits to consumers. You can’t do that without an open API environment where you can connect to vendors in a seamless way, and you can’t do that on top of a legacy platform. You need a digital platform that has open APIs that can interact in that way.

At EIS, we can help you do just that: change your legacy systems to get you closer to achieving true care orchestration, which ties together the provider, CSR, clinician and health coaches together in the same, unified experience. It provides an experience that members want, and brings health insurance companies closer to achieving true digital transformation.

While legal and compliance guidelines created the jargon complicating today’s healthcare insurance experience, there’s no reason for legacy systems to hamstring true digital transformation in the industry. Changing these legacy systems can help health insurance executives not only tap into the empathy that grew during the pandemic, but also ultimately speak their members’ language.

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