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A Health Plan’s “No Regret” Strategy to Open Enrollment


This year, health plans need to focus on the following smart, “no regret” investments in the enrollment process that have low risk, high reward, and ultimately deliver an exceptional member experience while simultaneously reducing costs and improving data quality.

Open enrollment this year will provide a glimpse into what healthcare will look like in the next decade. While COVID-19 cases have decreased significantly since 2020 or 2021, there is still uncertainty in the healthcare market ahead.

Will consumers’ hyperfocus on their health and wellness extend beyond the pandemic, leading them to choose plans that offer more robust wellness packages? Will people who left their jobs during the “Great Resignation” reenter the workforce with a focus on innovative health plan offerings for their families? Will inflation affect consumers’ priorities when choosing their health plans?

Now is not the time for health plan leaders to sit back to see how the market will shape out. Relying on old enrollment playbooks and “business as usual” approaches will set health plans behind competitors. Instead, plans need to focus on the following smart, “no regret” investments in the enrollment process that have low risk, high reward, and ultimately deliver an exceptional member experience while simultaneously reducing costs and improving data quality.

Create On-Demand Consumer Experience

The pandemic accelerated the consumerization of healthcare. For example, during the height of the pandemic, consumer telehealth use was 78 times higher than the same period before the pandemic. Even today, telehealth use is 38 times higher than pre-pandemic, indicating a lasting consumer shift to getting care at their convenience.

Similarly, today, consumers are looking for an on-demand enrollment experience. While we are still holding our breathes for when members can custom-build their enrollment packages, health plans should look for an opportunity to enhance the consumer enrollment experience by focusing on digital transformation investments that improve the transparency of the process and enable a more customer-centric experience.

Implement Intelligent Workflows
A health plan’s ability to innovate is substantially enhanced by the quality of data retrieved about members during open enrollment. Health plans that rely on legacy enrollment systems with little operational flexibility will lose the opportunity to collect meaningful data that can propel other functions of the business forward, such as value-based care programs, population health, proactive outreach, and risk adjustment capabilities.

Adding in a layer of intelligence can help ensure enrollment data is being captured, deciphered, enriched and codified accurately. This will also significantly reduce the need for manual enrollment file management and decrease the risk of costly, and often public, data errors that can lead to issues down the road during coverage determination and claim adjudication.

Prepare for Another Strong Public Exchange Enrollment
According to the Department of Health and Human Services, 14.5 million people enrolled in the marketplace through January 15, 2022 – a record high.

This year, health plans competing on the state exchange should prepare for another strong marketplace enrollment. Why? First, as state enrollment periods were extended due to the pandemic, there are now more plans in the market looking to compete. Second, with more plans competing for market share, consumers will begin shopping around, which will cause more churn. Health plans will need to differentiate themselves by leveraging data to tailor their offerings in conjunction with innovative pricing strategies. Finally, the pandemic increased consumer awareness about their personal healthcare, leading more people to enter the exchange to ensure they are covered.

With still much uncertainty ahead about the future of healthcare in this new post COVID-era, health plans should pursue strategies that focus on digital transformation to enable a more consumer-centric buying process and increase efficiencies and scale. The health plans that will be successful this enrollment season will focus on proven investments that enhance the member experience and ensure improved data quality and technology modernization, while staying flexible to adapt to growing lines of businesses, such as state exchange programs.

Aaron Fulner is a senior director at Edifecs focused on insurers involved in commercial, managed Medicaid, Medicare Advantage, and dual eligible programs.

Trey Keller is the vice president of product management for the consumer enrollment product line at Edifecs, leading all product strategy and development for a suite of products targeting the healthcare enrollment space.

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