As consumerism grows, payers must capitalize on open enrollment


Most Americans have health insurance today, but according to new research from Xerox, only three out of 10 are very confident that their current health plan is the best fit for their family.

Most Americans have health insurance today, either through an employer, Medicare, Medicaid or the state and federal exchanges, but according to new research from Xerox, only three out of 10 are very confident that their current health plan is the best fit for their family.

KurschnerUnderstandably so. Enrolling in a health plan in today’s ever-changing healthcare landscape is anything but simple. From deductibles, to copays, to in-network and out-of-network providers, the enrollment process can be frustrating and confusing. In addition, new technology has changed the way people enroll in a health plan altogether, enabling them to shop online for health insurance the same way they would shop for new shoes or books on Amazon.

However, the shopping experience is nowhere near as user friendly as what consumers experience with their favorite online retailer.  One-click checkout, anyone?

In fact, Xerox’s survey, which received more than 2,000 responses from U.S. adults, found that among those who have health insurance (1,937), more than half have experienced one or more challenges with the open enrollment process including frustration with the enrollment process, not understanding their healthcare options and being asked the same information more than once.

Why this presents an opportunity for payers

As the cost of care continues to rise and provider networks and drug benefits change and evolve, consumers need help understanding their benefit choices and the financial implications that may apply. This is an opportunity for payers to start a dialogue and enhance the member experience-even potentially gain new customers.

Though many Americans today are more involved and knowledgeable than ever before about healthcare and are even leveraging technology to make more self-informed decisions about their care, health insurance representatives have a better understanding of the enrollment process and the benefits that apply, and can lead members through the right set of questions, including:

  • Did you participate in the open-enrollment process last year? Why or why not?

  • What about your health plan worked for you last year?

  • Did you choose benefits that aligned well with your family’s healthcare needs? If no, where did the breakdown occur?

The good news for payers is that data analytics and automated tools can provide health insurance representatives with the individualized information they need to have informed and knowledgeable conversations with members. This can include a health history review, information mined from their medical claims or individual health risk assessments, which can provide better insights about a person’s health status.

It brings us one step closer to that nifty “users-who-viewed-this-also-liked-this” feature on so many online shopping sites.

And for consumers, it’s what we’ve come to expect. This not only improves the member experience, but also promotes overall member health by allowing insurers to identify conditions early on via pinpointed risk factors, assist members in managing of chronic medical conditions and maintain overall wellness by providing individualized health itineraries.

Nearly 70% of consumers will be participating in open enrollment this fall, meaning that they will be deciding whether to switch or stick with their current health plan. If they shop for health insurance on a state or federal healthcare exchange, they may also be deciding whether to stick with their current health insurance provider.

It is the payer’s best interest to ensure Americans are satisfied with their health plan, understand their benefits and enroll in a plan that meets their family’s dynamic needs.

Kristine Kurschner is vice president, client management and commercial payer strategy leader, at Xerox.


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