As Health Reform continues to unfold, the pace of change is picking up speed, as new models of reimbursement, care delivery and access are taking shape.
These shifts on the provider side should represent good news for millions of Americans that need better support from the healthcare system, especially since many of those with chronic disease aren’t currently getting recommended care. Coupled with the fact that most patients do not adhere to their medication and treatment regimens or recommended lifestyle and health behavior changes, and it’s easy to spot some of the challenges ahead.
Here’s where the payer side, particularly health plans, can really help.
Health plans have ready access to claims data and other relevant clinical information plus a direct line to their members for targeted messaging and clinical interventions. While not a traditional strategic imperative, health plans do have a significant opportunity to help drive behavior change, reduce risk, and produce positive health outcomes for their members.
Most plans already provide member portals and other helpful resources, and many have begun to focus on enhancing these activities and initiatives to enhance their value and impact. But, to compete effectively, in this rapidly shifting market, they will need to re-orient their mindset and approach to be far more consumer-centric.
Consumer Power
After a decade of slow growth, Healthcare Consumerism has begun to take hold. Participation in high deductible health plans (HDHPs) is at a record level with 23% of all those with employer-sponsored insurance now enrolled in an HDHP. Other emerging factors such as price comparison tools, quality ratings, and retail health alternatives will continue to put more power into the hands of consumers.
Health plans need to respond to this trend and design strategic solutions or partner with best-in-class service providers for their member populations. This puts a greater burden on member engagement outreach and interactions that are positive, relevant and trust-building.
This will not be easy. Recent surveys reveal a deep trust https://www.kuendigung.services/ gap between insurance companies and their members. The KMB Group survey of 34,000 consumers, find that only 22% of members identify their health plans as a “trusted source.” This compares to 80% for physicians.
And this year’s American Customer Satisfaction Index (ASCI) report indicates that customer satisfaction with health plans declined between 2013 and 2014, stating, “There is no area where health insurance companies offer an outstanding experience.”
Member Engagement
Member engagement is new territory for most health plans, and with Medicaid expansion, the influx of age-in Medicare members and the newly insured, it is increasingly important to provide consumer-oriented communications interactions, and interventions.
As Star Ratings and other quality metrics rise in prominence, and consumer brand preference and loyalty begin to become important factors, health plans will find themselves striving for excellence in consumer experience, though outstanding member engagement.
We see a number of areas that need to be addressed in developing an effective member engagement strategy: