Keep up with patient demands: Tips for MCOs


Patients are demanding more from payers and providers. Here’s how technology can help.

As more patients receive healthcare coverage outside traditional employer plans, health plans have had to adapt their engagement strategies. More than 11.5 million people signed up for coverage in health insurance marketplaces during the 2017 enrollment period, with 2.6 million new consumers, according to CMS. In total, more than 20 million Americans now have healthcare coverage due to the Affordable Care Act (ACA). With so many new consumers in the system, plans are rethinking onboarding and educating new members.


“Before the ACA, we had about 10,000 consumer members, now we have more than 100,000,” says Ryan Petrizzi, vice president, consumer markets and sales operations at AmeriHealth New Jersey.

With that increase in consumer members, Petrizzi says the health plan is using new technology to build communication and engagement. “We had to beef up our technology and offer services like online chat and text to renewal. We did a study of our members, and found out that consumers find their doctors through search engines, like Google. So we modified our online search tool to look like a search engine,” Petrizzi says.

Consumer demands in flux

Aside from keeping up with new member needs, plans also face higher consumer expectations. They want more price transparency, and more convenient and affordable provider options.

According to the Deloitte 2016 Consumer Priorities in Health Care Survey of 1,787 consumers, 58% of healthcare consumers say providers should provide cost information. Consumers also want more access and convenience. For example, 42% of healthcare consumers have used an urgent care clinic, and this figure is highest among millennials at 56%.

Due to the increase in healthcare consumerism, plans must prioritize segmenting and understanding their audiences, and use the right tools to engage and activate them, says Leslie Read, principal of health plans customer transformation solutions with Deloitte Consulting, LLP.


“Healthcare consumers are unlike typical consumers. Their experiences are varied and complex as they engage with multiple parties on emotional and personal topics. Healthcare is not a simple, one-time transaction with a single seller,” Read says.  “Healthcare consumers face a multitude of options for services and are forced to use a confusing payment system. And, as we all know, the stakes are much higher in healthcare than in typical consumer transactions.”

Find the right technology

Health plans need to be selective, and not bombard members with every new technology on the market, says Read.

“Since the passage of the ACA, there has been a proliferation of digital consumer engagement tools,” she says. “Taking a step back to block out all of the noise and better understand your consumer population helps organizations focus in on the consumer engagement tools and methods that will best suit their consumers’ needs.”

AmeriHealth offers a virtual assistant and chat capabilities on its website to allow members to engage in a way they prefer, says Petrizzi. The plan’s text to renew service (which allows members to renew their account via text message if they have no changes) and mobile apps with electronic ID cards, have been very successful with consumer members, he adds.

The plan’s strategy is to look to successful consumer brands such as Amazon when it comes to using technology to make the healthcare journey easier for members. “Consumers want to engage when they want to, the way they want to,” Petrizzi says. “All other industries rely on heavy technology tools to do business with consumers. We have to leverage the fact that consumers are already accustomed to a high level of technology.”

Next: Increase communication



Increase communication

Only 7% of healthcare consumers understand the basic principles of their health plans (plan premiums, deductibles, co-insurance and out-of-pocket maximum), according to the 2016 UnitedHealthcare Consumer Sentiment Survey of more than 2,000 consumers.

It’s critical for plans to help new members understand their plans and what their plans offer, such as preventive care, says Peter Serio, vice president of customer experience for Florida Blue.


“The lion’s share of attention goes toward those who are managing one or more chronic conditions; those populations are receiving plenty of attention. We still have work to do to determine the right type of engagement for healthy individuals and preventive care, especially in individual markets,” Serio says.

Petrizzi says AmeriHealth responded to an increase in Spanish-speaking consumers by creating renewal information, a shopping website, and sales and customer service departments in Spanish.

“As an industry, we need to do a better job overall of segmenting the consumer population. We hope that we can continue to segment our services as we learn more about our customer needs,” Petrizzi says.

Prepare for the future

Regardless of a possible ACA repeal, experts say health plans should continue to step up their technology and patient engagement goals.

“In many ways, potential changes to the ACA will have no effect on how health plans market to patients, since so many of the forces of consumerism in healthcare have come from outside of the healthcare industry altogether,” Read says. “Healthcare consumers’ attitudes, beliefs, and behaviors are being shaped by their experiences outside of healthcare with companies like Uber, Amazon, Netflix, and others.”

The likely in HSAs and HDHPs will put even more pressure on health plans to provide product and service options that are personalized and transparent for consumers, says Read.

Serio agrees, noting that the silos that have separated healthcare in the past will no longer serve consumer needs. “In the next five to 10 years, healthcare organizations will transform to look and feel like any other consumer company,” Serio says. “Health plans should be investing in capabilities that have enabled best-in-class consumer companies to set the bar, such as consumer insights and analytics, multi-channel and flexible IT architecture, and the consumer experience.”

Petrizzi predicts that consumers will demand a more holistic approach to healthcare, and that partnerships between health plans, hospitals and providers will be key to meeting that need.

“You will also see more integration with the provider community and a more holistic approach to patient care,” he says. “When health plans, hospitals and providers can truly partner, it is a very different conversation. I can see more integrations of those types in the next five years, as we continue to improve transparency of costs.”


Donna Marbury is a writer in Columbus, Ohio.

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