Three Ways to Better Manage the Healthcare AEP   

The Annual Enrollment Period (AEP) is a hectic time for insurers, healthcare providers, and employers. Healthcare plans are one of the most complex insurance products, and during the AEP, stakes are at an all-time high. If individuals make the wrong choice, they’re often stuck with their health plan for the rest of the year. This is why support lines get inundated with calls, and though insurers and employers have tried to manage volumes by promoting online resources, healthcare is just one of those issues where people seem to prefer personalized, one-on-one advice. Don’t ditch the technology yet. There are still three ways you can better manage the AEP using a combination of technology and people. It’s about balance and knowing how to leverage the benefits of each. 

Getting Ready for Open Enrollment  

For most Americans, there is but one time a year when they can enroll, cancel, or make changes to various medical health or ACA (Affordable Care Act) insurance plans. The annual enrollment period generally takes place from November 1 to December 15, with some enrollment periods extending into January.  

When that time comes, insurers, healthcare networks, and HR departments often get overwhelmed with the sheer volume of plan inquiries, especially if someone is nearing the age of 65 and is planning to enroll in a Medicare plan. Members may also be looking to add coverage, or change their plans to include prescriptions, dental, or vision, and may have questions about their benefits, copays or premiums.  

But did you know that according to new surveys, only a third of Americans understand how extended benefits work? Only 3 in 5 Americans 65 or older realize that Medicare is run by a federal agency and only 1 in 3 know how that coverage works when traveling abroad.  

Employers also face a significant “information barrier”, especially if employees are new or there have been recent changes to employee plans. The same surveys found that over 30% of employees are not confident in understanding how their plan works. Over half weren’t even aware they could compare treatment or service costs to reduce out-of-pocket expenses. 

Inflation has also caused many Americans to feel more financial stress. Almost half are looking for ways to cut back on daily expenses and they may be looking to optimize their healthcare plans and employer health benefits by spending more time this year reviewing their options.  

Yet, the window of the AEP is short, which means people will be searching for straightforward ways to access information, compare costs, and find support, especially if they have complex, policy-related questions.  

AEP Challenges Often Require Live Support 

The main challenge for any insurer, health network, or employer is making sure that new and existing policyholders get the help they need to make educated decisions about their medical coverage, especially if they intend to make any changes during the AEP.  

With the AEP’s short duration and the complexity of healthcare plans, communication needs to be fast, clear, and consistent across all customer-facing channels. People need effortless ways to compare coverage, premiums, and diverse benefits, and when they have questions, knowledgeable support teams should be ready to assist.  

You would think that turning to online resources, like insurer websites, would be one of the best ways to provide health plan information, and to ease call volumes during the AEP. However, surveys reveal that one-on-one personalized guidance is viewed as much more helpful (84%) than many online resources (68%).  

Healthcare is also an extremely sensitive and personal topic for many people, particularly at a time when 63% of Americans feel a high degree of financial duress. Out-of-pocket medical costs have risen much faster than workers’ wages, leaving 40% of U.S. adults with medical-related debt. This could make the AEP a uniquely stressful time for those who struggle to find affordable coverage. Which means individuals may need more one-on-one assistance comparing plan benefits to ensure they align with their health and financial goals.  

Three Ways to Better Manage the AEP 

Despite best efforts to promote cost-effective, efficient self-service, some will inevitably want to speak with a live agent, so is there a way to ensure that those higher, unpredictable call volumes don’t inundate your internal support teams during the AEP? 

Gently Encourage Non-Voice Channels 

When faced with higher call volumes, the best remedy is not to force your customers to use self-serve channels, but to make it their preference by providing members with options that are more direct and less time-consuming than voice calls. Your AI workforce, whether that is an AI chatbot or IVR, should be able to quickly answer simple inquiries or point customers to online resources like FAQs. If they link to helpful pages where people can find the answers they seek, customers may not feel the need to speak to a live agent. The other choice is to offer customers digital channels first, like email, text, and live chat support. People may like the convenience of these 24/7 channels but may feel reassured by having a human in the background. Digital channels also require fewer staffing resources because agents can interact with multiple members at once.  

Use Advanced Analytics to Enhance Efficiency 

The best way to serve your customers is to have immediate insight into the trends and patterns affecting your support channels. That way, you can ensure that you have the right staffing levels at busy times and the right agent training to ensure prompt call resolution. By spotting recurring issues and questions quickly, you can also update your online resources and chatbots, thus helping to divert calls away from inundated support teams. For that to happen, you need easily accessible data. A post-call analytical platform, like our itelligence, uses AI to immediately extract and analyze call data as soon as a customer interaction is complete. This allows Ops teams and clients to see key data visualizations and insights immediately, not days after a call, enabling faster operational decisions about staffing, training, and call routing. 

Outsource Frontline and Back-End Processes  

Remember, outsourcing can offer a way to quickly scale your support channels while also managing costs. Many outsourcers already have networks of skilled, licensed insurance agents that they can tap into on demand, which lowers talent acquisition costs. They can provide you with well-trained agents who know how to handle the sensitive issue of healthcare with empathy and understanding. For instance, itel agents are particularly skilled at helping seniors navigate the complexities around Medicare Advantage plans, and Medicare Supplement plans. Our non-licensed customer care agents can also ease the pressure off your licensed agents by answering simple plan inquiries. They can help with back-end processes, such as claims processing or billing, so licensed agents can focus on sales and new enrollments during the AEP.  

The Right Balance Between People and Tech

The good news is that it’s not a matter of whether you use technology or people to support your members. It’s about finding ways to blend the benefits of automation and AI without losing the sensitivity, empathy, and human connection that is so needed during a stressful time like the AEP.  

Our flexible, scalable CX delivery can help you manage higher call volumes, with experienced agents who can guide callers through the details of each plan, answer complex questions, and respond to buyer cues.  

If you’re looking to add new automations, chatbots, or timesaving digital channels, we can help with tech development, testing, and deployment. Not just automation, but AI tools that help boost the efficiency and productivity of your existing agents, while keeping that delicate balance between tech and human touch.  

Want to learn more about our flexible, scalable customer experience management? Click here.