Health plans must own member CDH experience

August 1, 2008

The evolution of consumer-driven healthcare (CDH) has increased the demand for value-added services from health plans. The ability to offer these new services is a prerequisite for those hoping to succeed in the CDH market.

The evolution of consumer-driven healthcare (CDH) has increased the demand for value-added services from health plans. From financial account management to payment processing, the ability to offer and support these new products and services is a prerequisite for successful health plans in the CDH marketplace. Moreover, healthcare is transitioning from a wholesale to a retail model of delivery, and carriers must embrace applicable product and service approaches.

According to the annual census by America's Health Insurance Plans (AHIP) of U.S. health insurance carriers, the number of people with Health Savings Account (HSA)/high deductible health plan (HDHP) coverage rose from 4.5 million in January 2007 to 6.1 million in January 2008. Additionally, the analyst group Celent predicts the HSA market will grow as much as 60% in 2008, primarily driven by employer adoption, with 43% of all employers recently surveyed saying they will offer HSAs or HRAs to their employee base in 2008.

As the financial account component of a CDHP is an entirely new business function/service for most health plans, many early-entry strategies involved referral relationships with banks or no relationships. These early approaches have proven problematic, as the HSA/HDHP were sold separately and integration of servicing the products was disjointed. This created a great deal of dissatisfaction on the part of employers and individuals who used these accounts and is one of the main reasons why today nearly 10% to 14% of all HSA accounts are duplicates.

Customer service ownership

Unlike traditional health plans, a statistical majority of activity within CDHPs occurs sub-deductible. The increased individual risk retention associated with the CDHP means that members are spending more time on the financial aspects of healthcare management until the deductible is satisfied. In situations where a banking institution serves as first point of contact in addressing account concerns, a disjointed customer service experience occurs, as the banking institution is not equipped to address their healthcare questions. This can negatively impact a consumer's overall satisfaction with their CDHP.

For comparison, the average time it takes to service a traditional checking account telephone call is 50 seconds. However, the average duration of an HSA customer service related call is nearly three minutes, requiring specialized training from the support representatives who service the calls. Most banks/financial institutions simply are not able to offer an adequate level of customer service support for HSA customers. This becomes increasingly problematic as consumers inquiring about their HSA accounts also need support in areas like claims management. The end result when these functions are not integrated is that a consumer must first call their financial institution, then call their health plan, and are left stuck between the two entities with neither one being able to adequately supply information needed.

Data ownership

In CDHP environments, health management is inextricably linked with healthcare spending and wealth management. Yet, in an environment in which a financial institution serves as HSA custodian, given the majority of activity within an HSA is taking place sub-deductible, ownership of the data related to customer healthcare spending also resides with the financial institution.

For health plans, the ability to have visibility into actual customer/client healthcare spend and usage patterns, and to use that data to better understand and meet customer needs/objectives is critical to the long-term success of any CDH program. However, for health plans that do not control the entire member experience-including administering to and serving as custodian of a customer's HSA-this ability is lost.

Controlling the member experience

The only way for a health plan to truly own and control the CDH member experience is to own and manage not just the administration of the CDHP, but also the technology associated with the financial account system. Increasingly health plans today are beginning to outsource healthcare banking technology platforms that enable them to:

By owning the healthcare banking platform technology associated with the financial account system, health plans that pursue this model are able to ensure end-to-end customer support services for their members, guaranteeing uniformity of customer service response and customer service representative accountability.

Additionally, upon deployment of healthcare banking platform technology, health plans not only gain access to critical customer sub-deductible spend data, but also gain access to even more granular customer information such as who the spend is for (which dependents), where the spend is going (which providers), and how the payment is made (card, reimbursement, etc), all of which can be used in plan revisioning, enhancements, and new service offerings.

In today's CDH environment, controlling the member experience is critical to any health plan interested in rolling out a successful CDH initiative. Health plans must not only administer CDHPs, but also need to own/control the technology associated with the financial account system giving them the ability to directly administer the financial account. Outsourced healthcare banking platforms allow healthcare companies to quickly and affordably launch CDH account management capabilities to increase top line revenue, create a seamless experience between plan enrollment and account origination, and in most cases establish multiple banking partnerships to grow fee income. Platforms that also support business processes such as eligibility, enrollment, account management, claims submission, expense substantiation, receipt storage, reporting, analysis, customer service and IRS regulatory form filing automated and executed entirely online, offer health plans the greatest market advantages, and the ability to build successful long-term service relationships/trust with their CDH client bases.

Vik Kashyap is the CEO of Canopy Financial, which provides solutions for financial transactions in the consumer-directed healthcare industry.