What health plans should do during open enrollment season

As health insurers become increasingly more proactive and personalized in their interactions with individuals, they increase their ability to improve the cost and quality of healthcare while building loyalty in a competitive market.

Open enrollment season is one of the busiest times of the year for health insurance companies as people research their health plan selection options. Unlike shopping for holiday gifts, which can trigger feelings of anticipation and excitement, the process of selecting health insurance can be the emotional equivalent of preparing income taxes. Although people may never eagerly await either process, health insurers can gain trust and loyalty during the open enrollment season by providing an educational and personalized shopping experience.

For the last 60-plus years, the tasks of researching and selecting health insurance have largely been performed by employers and experienced benefit consultants. As employers continue to extricate themselves from these functions and a greater portion of the population becomes eligible for government-sponsored individual plans, the roles and responsibilities of consumers have grown.  Unfortunately, health insurance economics and risk analysis are not strong suits for most Americans, leaving them ill prepared (pun intended) to capitalize on their increasing market power. 

Amidst all this change, health insurers have an opportunity to earn and keep loyalty by providing personalized and proactive service before, during and after open enrollment.

Enrollment tips

To assist people in selecting a health plan, insurers and marketplaces provide questionnaires, calculators and other tools to predict healthcare risks and costs. Despite these resources, people often end up selecting plans that are not best suited to their situation. Research from Columbia Business School suggests that more than 80% of people may be unable to make a clear-eyed estimate of their healthcare needs and will unknowingly and unnecessarily choose a higher cost plan.

To improve the shopping experience, health plans are reaching deeper into their tool chests, which include sophisticated health risk and cost modeling capabilities. When these capabilities are enriched with an ever-increasing amount of population and shopper-specific data, insurers can further refine plan options and provide the supporting rationale for each. Though no algorithm can perfectly predict the future healthcare needs and costs for an individual, a well-designed shopping experience can reduce buyers' remorse and sticker shock.

Next: Post-enrollment tips



Post-enrollment tips

The accuracy and completeness of information submitted to health plans during enrollment remains problematic. For example, current application processes often request one phone number or email address per household. If people better understood how this information would be used for their benefit, they may choose to provide alternative or additional contact methods.

Through a recent experience, I learned the hard way that mistyping a single digit in a birth date field can delay benefits and result in several frustrating interactions with a health insurer. A personalized interaction with the individual or decision-maker shortly after enrollment could address many such scenarios and improve the cost and quality of the services provided. 

Technology can serve as a powerful enabler in these interactions. An intelligent (i.e. tech-enabled) welcome call can not only identify and correct an incorrect address, preventing volumes of returned mail, but could also update a list of valuable community resources available to the member.

The dynamic nature of the interaction means that as the individual provides or validates information, the call agenda can be reprioritized accordingly, increasing the value and satisfaction of the experience.

By going beyond traditional welcome kit mailings and welcoming people in a personalized, interactive fashion, all parties can benefit.

David Rauch is payer offering lead, Xerox Commercial Healthcare.