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Four Ways Health Plans can Guide Members to Wise Choices


For all health plans, increasing complexity requires rethinking the presentation of options to members. Choice design, stepped information reveal, high quality, and timely communication, are keys to providing members a helpful and trustworthy healthcare GPS.



Tiering and steering are among the buzzwords being thrown around today that relate to helping health plan members select high-value providers. And while there are numerous reasons for enacting a strategy to guide members to specific providers, careful consideration needs to take place in order to preserve trust with your members. That’s why up-front planning and strategizing with a lens on consumer experience is paramount. 

There are challenges that come with introducing ways to guide your members to ideal providers in their online provider search experience, but here are four ways to build your experience and maintain trust with your members throughout the process.

  • Simplify language to convey complex ideas.

If you use complex terms and concepts right up front, you’re going to lose the majority of your members. Research into member literacy about core health plan concepts have revealed that most people don’t understand even the most basic concepts and language. In fact, a recent survey revealed that only 4% of people are health insurance literate. Understanding that most people aren’t health care experts and putting yourself in their shoes are important steps to creating an experience your members understand.

In addition to the unfamiliar language and concepts presented to health plan members as they attempt to make choices, the sheer number of doctors available can be overwhelming. Taming that list of doctors to a group that is relevant to member’s needs helps them make a choice, rather than paralyzing them with too many options. Over and over, members tell us, “I can choose among five or 10 but not 1,000!” Lists upon lists of doctors (or anything for that matter) just aren’t helpful to people – and ultimately not helpful to you, as a health plan. Members will get frustrated or overwhelmed and call for help – or will simply choose the first doctor on the list regardless of whether or not it’s a good fit so as to avoid ultimately making a choices among too many choices.

   2.  Build a walled garden.

One insurance concept that has reached wide acceptance and understanding among Americans is “network.” Most consumers with health insurance have learned the importance of staying “in-network” and use directories to understand if a provider is in their plan. With this understanding comes the mental model that network status is binary-that a provider is either in or out of network.

This now somewhat simple binary concept of network is being complicated as plans introduce the idea of tiering to their networks. This is a completely new concept that complicates the status quo as some doctors are now “more in-network” than others. The decision a member must make is increasingly complex.
Members want options, but we need to minimize choice overload. Allowing members to choose among all good options (at least with regard to plan rules) enables them to only make a good choice without being overwhelmed. This guidance is like choosing flowers in a walled garden: any of them are good options and the selection criteria becomes one of personal choice.

   3.  Take the burden off members wherever possible.

You might ask, will serving a selected group of providers in a walled garden approach just send members to Google? But, when it comes to designing your doctor selection tools, a walled garden could display only top-tier providers by default, which would allow users to opt-out if they want to see a wider selection of options. In the walled garden model, members do not have to know all their plan details and rules before narrowing down and comparing their options. They are shown only good options that fit with their plan and their needs, right from the start.

This approach takes the burden of asking members to locate top-tier providers among an entire field of flowers away by giving them some beautiful flowers to choose from right up front.

   4.  Be very transparent about your selection criteria.

No matter how you slice it, successful guidance requires trust through transparency. So, the selection criteria your health plan is using to put certain providers over others in the walled garden needs to be very clear. It is important to tailor messaging to help members understand and explore the reasons behind the suggested selection of doctors (and learn about tiering or quality initiatives in the process). In addition, providing a way for members to expand their search among all the options, should they choose, preserves the balance of choice and control, which builds trust and supports good decision making.

For all health plans, increasing complexity requires rethinking the presentation of options to members. Choice design, stepped information reveal, high quality and timely communication, are keys to supporting members to make the best healthcare choices.

How are you, as a health plan, managing the complexity of network tiers while also maintaining a user-friendly experience for your members?

Alison Greco, director of user experience at HealthSparq. She is a psychologist with 18 years of experience in user centered design and research. Alison has spent much of her career in health care and is passionate about fusing psychology with research insights and creating great user experiences.

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