Most customers describe interactions with their health plans as confusing, disjointed, and redundant. Given how frustrated and disoriented members feel, improving the member experience must be a top priority for health plans that want to differentiate themselves from competitors. You can do that by rethinking your existing CRM strategy — shaping it into a tool that streamlines and enhances customer experiences — which in turn can help to improve your member relationships.

While it's true that CRM systems were originally designed for sales departments and are not ready-made to take on companywide processes, the tools the platforms do offer can be a boon to member management if you approach them the right way. For example, instead of continuing to hold your member data in multiple siloed back-office systems, you should consolidate the data into one cohesive profile that includes a history of every single customer interaction, from website visits to provider visits to communications. This can be achieved by building additional capabilities into your existing CRM software and then you can use it to provide the context for all member interactions and as a base for your sales and service analytical modeling.

Integrate to Communicate

Here's the ideal: No matter how a customer is interacting with your company — calling a sales rep, logging in to your member portal, emailing a claims rep — the member should be interacting with a system that knows who she is and has all the context needed to help the member take her next action. This ideal is possible only if you bring everything you know about customers into a single system built around them. If you make your CRM platform the big tent that houses all this information and customize it with smart modeling, the data can be accessed and used by everyone who handles any client interaction.

To begin with, you could integrate the CRM with the backend systems where your member data is actually stored and managed. From there, you'll need to build out your workflow so that health plan employees interacting with the system actually have the processes in place that drive proactive engagement with members that takes advantage of this profile and the analytical tools available in the CRM.

Build It Better

If you set up the appropriate data modeling, you'll be able to combine the analytics gleaned from those models with the automated actions already present in your CRM platform's toolset — emails, outbound calls, and others — to actually act on the conclusions you draw from your analysis.

Keep in mind that customizing your CRM to perform these functions is no simple task, and though it's easy to do, it's difficult to do correctly. However, if you are able to include these three key components in your current CRM system, you'll be one step closer to improving your customer relationships:

1. Complete data tracking and modeling

Process modeling and data modeling are the key drivers in implementing a more consumer-focused CRM system. As you set them up, make sure the processes are usable and the integrations are scalable. Your CRM platform doesn't come equipped with these capabilities out of the box; you'll need to develop software in-house or use a solution like our Member Forward™ app to set up the data modeling that delivers the comprehensive models and data-driven analytics you need for targeted member outreach and seamless customer interactions.

2. Comprehensive profile building

By integrating so much additional live data to your member models, your interactions with members will no longer be disconnected and context-less. You'll have enough data (and the permission to use it) to build comprehensive profiles that can easily scale as more data is added. In addition, you will always find new data and new systems to add into the connected platform.

For example, when members visit their healthcare providers, their doctors, nurses, and care teams track the visit and results on the provider's clinic management and EMR/EHR systems. If your future member relationship system can't easily connect and get access to that data, that creates a hole in your member's profile. At this very moment, new standards and approaches like Fast Healthcare Interoperability Resources and Center for Medicare and Medicaid Services' Blue Button initiative are laying out the groundwork for this integration. Your platforms will need to be extensible and integration-friendly to allow you to take advantage of this exciting new integrated future.

3. Easily leveraged member profiles

Creating comprehensive profiles of each member using your souped-up CRM system is just the starting point. The next step is to leverage those profiles to create highly personalized, truly customer-centric experiences. For example, you can recommend beneficial plan changes during open enrollment, guide members to relevant wellness plans after a hospital visit, or drive highly rated, proactive care management interventions — to name a few.

To make sure your profiles are leverageable, you must make member data available to everyone who interacts with members — with appropriate security and scoping in place, of course. Any touchpoint your member has with your organization should be informed by the data and analytics in his profile to create the "seamless" experience your customers desire.

The health plan industry is experiencing an avalanche of data, with information piling up about members from their care providers and increasingly sophisticated tracking systems: connected medical devices, fitness trackers, and the like. Governing bodies are seeing the light in terms of connecting patient data with other sources of data and analytics and are rapidly pushing the industry to compliance across the payer, provider, and patient/member environment. Carriers who can take advantage of this data to create the desired frictionless customer experiences are those who will avoid getting buried in the landslide.

The industry may be changing, but if you build some key capabilities into your CRM and keep your approach to implementation aware of the three principles listed above, you can gain a huge competitive advantage while other carriers struggle to keep up.

To learn more about how to transform your CRM platform into the member-tracking powerhouse you need to stay ahead, download the case study of our Affinity partnership or learn more about how Colibrium's Forward™ Apps can set your CRM up for success.