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Six ways health plans address consumer pain points


Consumers want more, and it’s time to deliver. Here’s how health insurers can retain current members and attract new ones.


By the time federal open enrollment begins November 1, Horizon Blue Cross Blue Shield of New Jersey intends to have what one executive describes as a “much simpler” consumer website so individuals know immediately where to find information. The insurer also is providing more bill payment options, and conducting major outreach to individual members. That outreach focuses on its plans’ broad value-including wellness products, telemedicine, prenatal care and free basic preventive services.

LaraSpurred on by the Affordable Care Act's emphasis on the individual market, Horizon is also pursuing targeted initiatives, such as the launch of a dedicated Hispanic enrollment and service center and mall kiosks with bilingual agents and Spanish-language materials. This is part of an ongoing marketing partnership with HolaDoctor. The upshot? Nearly 400% growth since 2013 to 30,000-plus Hispanic members-about 15% of the previously uninsured people who joined Horizon for 2016.

“We've had a customer-experience team since 2012 trying to understand the most important things our customers look for. … We're looking for 'pain points' and where to fix them for all members,” explains Ed Lara, Horizon's vice president of marketing and product development.

The health plan’s efforts are part of a national trend in which managed care plans are using an array of tools to improve members' individual experiences, build trust and become more understandable and accessible.

Long way to go

LindbergThe trend isn't surprising to consultant Ingrid Lindberg, chief experience officer at Chief Customer, a customer-experience consulting firm. Her clients include national carriers and Blues plans.

Yet Lindberg, who served as chief experience officer for Cigna in 2007, says the healthcare industry still has a lot to learn when it comes to the customer experience. “Plans have been doing consumerism...for years and it's not changing consumer experience with health plans,” she says. “Some plans have lots of [consumer] engagement tools and very low engagement scores.”

Larry Bridge, senior vice president of strategy and corporate development for TriZetto, a business unit within Cognizant's healthcare practice, says finding ways to better engage with consumers is key. “I think the key shift that healthcare hasn't made is moving from functional communication to real [member] engagement,” he says.

BridgeApart from investing in tools and technology, plans must consider individuals “longitudinally over time” and think broadly about how to address populations' preferences (such as not focusing on mobile apps for seniors), Bridge says. It’s important to have “24-7 multi-channel engagement,” ensuring members “can trust you to follow up and respect everybody's time” by not making them repeat information, he says.

In general, Lindberg describes a hierarchy of member needs: First, the plan must be “easy and understandable.” Next comes plan reliability. Only then will members be willing to ask questions, she says, “and that's where you start to build trust and earn the right to engage.”

Here are six strategies plans should consider when attempting to improve the customer experience:



Strategy #1: Simplify language.

“We know understandability is one of three major drivers of the customer experience, so the first thing I tell plans to do is simplify their language,” Lindberg says. People don't understand terms such as “coinsurance” and “provider,” and acronyms are overused.

GelburdRobin Gelburd, president of FAIR Health, an independent not-for-profit organization providing access to healthcare cost and insurance information, says plans must also clearly communicate basics, such as the difference between emergency care and urgent care and availability of telehealth. They also must explain how consumers may face larger out-of-pocket costs depending on their choices, she says.

“We see movement from transparency-making information and data available-to clarity,” Gelburd says. “Something can be transparent to your eye, but you don't know what it means ... so it's important to make data like a beautifully set table, making sense to consumers.”

Horizon’s activity provide a good example of how this guidance can be applied in the real world. It streamlined its welcome letter and, instead of sending the member identification card and welcome letter separately, now affixes the card to the letter, Lara says. ID cards now have a sticker attached with information on how to sign up for online member services, and consumers can phone-scan part of the letter to reach an educational video on how products work.



Strategy #2: Shore up basic information channels.

Consumers want to easily access information on the plan’s website, and be able to email and call the plan easily, Lindberg says. She says it's crucial to ensure basic channels are functioning well so responses are timely whether they are being given by phone representatives or by online chat. “If you can't nail the basics, then you can't open new channels,” she says.



Strategy #3: Open new channels.

Lindberg often discusses access with health plan clients. It’s “about being available through lots of different channels and being available on your customers' time, not your own,” she says. Most plans don't offer online chats or rapid responses, even though phoning a plan Monday through Friday, 8 a.m. to 5 p.m., is not convenient for many patients, she says. Find ways to be available to members 24/7.  



Strategy #4: Orchestrate communications.

Typically, plans only have 1.4 one-on-one interactions per member annually-whether through a conversation with a case manager, an email correspondence, or an interaction at an enrollment fair, Lindberg says. “Because you only have that one moment to get it right, language and access are important,” she says.

“I've found time and again plans tend to push information out [to members on clinical issues, claims, benefits, etc.] ... and it's not orchestrated,” says Lindberg. “So I say, 'Print and put all the pieces in a room and look at what the company is distributing and pare it back.’”

Also, ensure members are receiving correct information, she says. For example, a new member doesn't want inaccurate data about which physicians are in-network or accepting new patients. “You've got to fix the data on your doctors, because we know doctors in-network are one of the main reasons consumers choose you,” she says. 



Strategy #5: Streamline processes.

Plans must be proactive with new members, Lindberg says, by getting information on drugs that need prior authorization and making the process easier upfront. This could be done by making it a part of enrollment for new members, she says. If people are transferring between plans due to the employer changing the insurer, make medication continuity a part of the transition and do outreach to the members based on their claim data.

Plans must “let them know what they have to do so the new member has no surprises,” says Lindberg. “You can create a structure within the plan [in which] you'll never deny that first request to fill.”



Strategy #6: Show the value.

“In healthcare the costs keep going up, yet health plans aren't showing customers the value for their dollar,” Lindberg says. Plans must compare and communicate-telling members, for example, whether they're paying $100 for a medical service instead of $300 that non-members pay.

Aetna, Inc.'s online “Member Payment Estimator” shows what members will pay for common procedures based on their plan design and remaining deductible. In 2015, Aetna members got personalized estimates nearly 1.8 million times. Since its 2010 launch, the tool has gotten 6.6 million-plus hits, according to Aetna, and members using it are saving on out-of-pocket costs.

Fresh, clearly presented information creates a win-win situation extending beyond members' informed decisions and plans' administrative savings, Gelburd says. “It's creating a level of comfort and goodwill between the member and the plan that information is being provided in a way that brings [clinical and financial] value to consumers.”

Judy Packer-Tursman is a writer in Washington, D.C.

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