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As healthcare consumerism gains momentum, health plans need to change their offerings to keep up with consumer demands.
Today’s consumers have high expectations when making a retail purchase. These same demands apply when purchasing health insurance and getting medical care. Health plans that don’t meet customers’ expectations may be left out in the cold. The trend-dubbed healthcare consumerism-marks a shift toward greater consumer choice and responsibility.
As healthcare consumerism gains momentums, health plans need to change their offerings to keep up with consumer demands.
“They have ... to come to grips with the fact that the market was moving toward health saving accounts and high deductible health plans, and consequently lower premiums,” says Douglas Field, chief executive officer, The Institute for HealthCare Consumerism, Alpharetta, Georgia. “And because most plans don’t know how to act as retail businesses, they [are] pressured to become more consumer facing-especially in light of [Affordable Care Act] ACA adding a lot of individuals to the market.”
Customer retention strategies are changing, too. “Health plans need to win and retain members one at a time, as opposed to winning and retaining employer groups as they did in the past,” says Larry Bridge, senior vice president, strategy and corporate development, TriZetto, a Cognizant Company, in Englewood, Colorado. “To accomplish this, they need to create an entirely new experience to engage with individual consumers and they need to show value above and beyond simply paying a claim.”
InstaMed’s health plan customers are recognizing the importance of the consumer experience when attracting and retaining new business in emerging individual and group markets. “These health plans acknowledge that paying bills is an important part of the healthcare consumer experience, and have partnered with us to provide simple and convenient ways to manage their healthcare bills-where the health plan brand is front and center,” says Chris Seib, chief technology officer and co-founder, InstaMed, based in Philadelphia, Pennsylvania and Newport Beach, California. “This results in increased consumer engagement and satisfaction, and a stronger brand affinity.”
Health plans should take steps to better market to consumers and offer better customer service. Efforts to educate consumers about plan selection and management should no longer be concentrated around open enrollment season, says Robin Gelburd, president, FAIR Health, New York, New York.. “While enrollment-season guidance helps plan members make initial plan choices, members are often ill-prepared to make informed decisions as they access care and manage their benefits throughout the year."
Tools that can help consumers understand their cost-sharing options and plan for expenses in advance can add significant value to a member’s experience. For example, cost estimators on member portals can help consumers compare out-of-network costs to in-network negotiated fees. Cost estimator tools can also be paired with educational content that provides members with the vocabulary of insurance (e.g., deductible, narrow network, and copay) and principles associated with reimbursement and benefit design.
Bridge maintains that health plans need to be accessible. “Make it easy for customers to find, understand, and buy your product-whether they are calling or interacting via the web,” he says. “Make it easy for them to connect with you, whether in person, on the phone, or via mobile device. Remove barriers and equip your team with the training, tools, information, and incentives to answer questions seamlessly and efficiently.”
Health plans should also strive to be a trusted adviser to consumers and give them information to help them make informed healthcare decisions. “Help them shop for the best deal, and give them the information to make the best decision about their healthcare treatments-information that includes treatment costs, physician quality, and patient satisfaction levels with providers,” Bridge continues.
Adam C. Powell, PhD, president, Payer+Provider Syndicate, Boston, believes that in order to meet consumers’ needs, health plans need to anticipate potential challenges and then devise solutions for pre-empting them. One common problem is that members call their health plan representative to complain about unexpected charges. “This has been exacerbated by a combination of high deductibles and treatment cost estimators which are not provider-specific,” he says. “Simply offering provider-agnostic treatment cost estimates is not adequate, as most patients are not trying to decide whether they wish to seek treatment, but instead are trying to determine where they should go.”
In Massachusetts, by law health plans must offer members provider-specific treatment cost estimates in a timely fashion. “If health plans were to nationally create tools to enable patients to more easily obtain provider-specific cost estimates, they would both empower consumers to make more informed choices and eliminate the dissatisfaction and complaints generated by prices which are revealed after care is delivered,” Powell says.
Making changes to accommodate a consumer-oriented healthcare world is easier said than done. “With consumers becoming increasingly proactive in managing their healthcare spending, plans face the daunting challenge of trying to package information in a way that is both easy to understand and actionable,” Gelburd says. “The industry needs more and better efforts to reduce industry jargon and package information so that a diverse population can understand it. Insurers and plan sponsors should know who their members are and be aware of their needs in order to develop materials tailored to their particular audiences.”
In looking for ways to achieve this, Gelburd would advise healthcare leaders to look outside of their own sector and identify best practices that they can apply to healthcare. “Consumerism has always been the driving factor in many retail industries,” she says.
Bridge has seen many clients hire experts with retail backgrounds to facilitate the transition to a retail model. “To succeed, health plans will have to retool their businesses to think like retailers and focus on consumer-centric strategies,” he says. “Plans need to differentiate in a competitive environment, market to and attract new customers, transform the consumer care experience, and provide excellent customer service. They also need to engage with their providers in a similar fashion and enable collaboration across the consumer, payer, and provider experience.”
Powell says consumers tend to have inconsistent preferences, which is another challenge. “Consumers like low prices, great access to care, and high quality, but typically there is tension between the three,” he says. For instance, at enrollment, a narrow network plan offering only select providers in a region may seem like a great deal. When health needs arise, however, some consumers may regret making such a decision-as health insurance plans often bury details regarding networks. “Health insurers can help reduce challenges resulting from this issue by making their networks transparent on their websites and by building decision support tools,” he says.
The bottom line is that health plans cannot afford to ignore healthcare consumerism. “If plan members understand their benefits and have the information they need to manage costs and access services, they are more likely to derive satisfaction from their plan, renew their benefits, and have less reason to shop for new plan options,” Gelburd surmises. Additionally, “If consumers have a clearer understanding of their plan benefits and options, they will likely lodge fewer complaints and initiate fewer appeals and challenges with respect to reimbursement decisions.” So embrace healthcare consumerism, or expect customers to look elsewhere.