Healthcare in the UK is primarily dominated by the National Health Service, but amid NHS shortages and long queues, private healthcare is rapidly growing.
Average annual growth was 6.1% between 2020 and 2022, compared with 1.7% between 2008 and 2019, according to health data provider Laing Buisson, with around 4.8 million people signed up to medical cover schemes- that rises to 7.3 million once dependents are included.
Simplyhealth is one of a handful of private providers in the UK tasked with connecting those who need care with clinically vetted health professionals. Claudia Nicholls, chief customer officer at Simplyhealth, explains: “The pressures on the NHS are well publicised – we think that it is not right that so many people in the UK do not have access to healthcare.
“Where we are perhaps different from other private medical insurance providers is that we are operating in Britain trying to offer affordable everyday healthcare,” she says.
The group serves around 2.5 million and this is growing – with bold targets to hit as many as 10 million subscribers in the next few years.
“That would mean people could get access to their everyday healthcare needs while working in Britain pretty much instantaneously and see a healthcare professional either digitally or in-person,” explains Dan Eddie, customer services director at Simplyhealth.
Given that the company was founded more than 150 years ago, it has been, in many respects, a “very traditional” business, explains Eddie.
More recently, Simplyhealth’s leadership has been “very brave” in recognising that and embracing digital transformation across its products, technology and how its employees work.
He describes the healthcare provider’s digital transformation journey over the past three years as “pretty phenomenal” as it moved away from traditional analogue platforms and forms of customer service into a digital, omnichannel environment.
Simplyhealth’s tech transformation began when Eddie joined in November 2021 but it accelerated significantly when Nicholls arrived from money management and budgeting platform Snoop a year later.
“The role of tech – in the past 12 months – has accelerated in our organisation in terms of confidence,” she explains.
For Simplyhealth, the first key area of transformation has been around customer services. They acknowledge that the firm had been “inconsistent” in its delivery of good customer outcomes but were wary of introducing AI without supporting the business’s growth trajectory.
After onboarding Salesforce’s Einstein for Service AI solution, the healthcare provider has leveraged conversational AI tools on its customer calls, with the AI now accounting for 40% of all resolved calls. The system has also reduced response times for emails from 12 minutes to just one minute since launch.
“We are here to help people, but often using AI is labelled as “deflection” which is a real problem for our industry. For us, it is resolving customer issues, and that allows us to be open 24 hours a day, to stay open at Christmas, and allows our team to focus on other areas, because the boring work can be dealt with by technology.”
The private health firm’s use of automation has expanded beyond customer response, to also include processing of customer claims – something that they admit was seen as a bit of a risk initially.
Due to the complexity of payments and risk of fraudulent claims, many in the industry are risk averse when it comes to automating the claims system. To overcome this, Nicholls and her team investigated the cost of when someone complains about their claim experience to the business.
The team then calculated that any claim that is worth less than this value could be automatically approved because it is never going to cost more than the bad experience.
This realisation, she adds, triggered a rethink of Simplyhealth’s approach to claims. After putting income controls and fraud checks, it increased the value of claim that could automatically be approved.
Simplyhealth now uses Salesforce’s AI to process claims from customers looking to get money back for any procedure so that they can potentially put the money back into the customer’s pocket on day one.
“This new level of claims automation means the claims experience is first class,” says Eddie. “How do I know that? Because of feedback. 99% of our customers say they satisfied with out claims procedure, and 92% say they a very satisfied.”
This has also reduced the amount of complaints coming into the business. In January 2023, it had 600 complaints in its pipeline, and two thirds of these were related to payment claims. Automating that number has meant that month on month through 2024, it has seen a huge reduction, says Eddie.
“When you are dealing with 2.5 million customers and receiving 40,000+ contacts a month, to reduce that number of complaints down to just 24 in the pipe – that’s my favourite outcome of this transformation.
“It is representative of the end-to-end experience that our customers have with us – it means we can offer all of them a wonderful experience.”
Simplyhealth selected CRM giant Salesforce for customer service transformation, from a list of 10 providers. According to Eddie, it was Salesforce’s ability to offer scale for growth, along with its future looking ideas around AI and automation, that really appealed.
It was already using Salesforce as its primary CRM, but switching to its AI and cloud offerings brought significant challenges – but it was still an “easy answer” says Eddie.
“You have to look forward to what is happening over the coming years,” he tells TechInformed. “You know Salesforce will be at the front of the AI journey and it was already our CRM partner, so it was trusted in the organisation.”
This buy-in from the rest of the business was vital to the plans to overhaul its customer services operation.
Nicholls agrees. “You need to have people who can look through a customer’s eyes, and a lot of vendors look at it through the view of the technology first. But technology is an enabler – it is not the endgame.
“It is also a question of if they are the right fit. Do they take action and will they allow us to transform? We don’t think the UK healthcare system is fair, or is working for everyone right now, so you need to have fire and flame to be able to create change. And you need a partner who gets that.”
Salesforce also helped deal with some of the potential regulatory issues. Health is a heavily regulated industry in the UK, which meant everything the company did was watched closely. But due to the size and experience of Salesforce, the software giant could refer to other clients it had supported taking their first steps down the AI path.
“We had to demonstrate good customer outcomes – it could be very detailed,” says Nicholls. “But what we are doing with AI is now moving into the area of quality assurance, by covering more of our customer interactions.
“Covering 100% allows us to kill two birds with one stone because the technology allows us to interact faster, and with fewer people, but it also puts a security blanket in place. We can share the data with them, and that helps get the regulator on board.”
For now, the healthcare provider is focussed on increasing its communications channels by integrating WhatsApp through Einstein.
“We think that could become our dominant channel,” reveals Eddie. “Then we can add a live chat and phone services through that, to really offer our customers a range of options.”
With AI already serving a key role in how Simplyhealth is serving its customer base, I ask if they expect to go even further down the AI rabbit hole. After all, we are meeting at Dreamforce, where Salesforce has just unveiled its new agentic AI solution, called Agentforce, and posters promoting the product are all around us.
The Simplyhealth team admit they are excited by the potential of tools like AgentForce, which could help them “build a cleaner experience” for customers, says Eddie.
Numbers wise, the firm is sending 1200 emails a day using Einstein, and the AI tool already saves around 95 hours a week in efficiency. But, within two years, accounting for all the tools Simplyhealth hopes to onboard, Eddie believes between 50% and 60% of all queries could be resolve by AI. The platform will also allow the company to offer support 24/7 for 365 days a year.
“We have been early adopters,” chimes Nicholls. “We take great pride in that. Our team is up ready to integrate any new Einstein updates when they are released, because even little changes can help our customers.”
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