Healthcare Insurers Changing to Consumer Model
Lori Gelter | February 24, 2014
Healthcare payers are dealing with a lot in the volatile market with expanding regulations. They are seeing inevitable changes in their business models and their product offerings, so they’re moving from a B-to-B model to a B-to-C model.
These individual consumers will be the new buyers of health insurance. The market is most likely going to increase dramatically over the next few years. Employer-sponsored benefits are going to be reduced, and with the Affordable Care Act, this is going to expand coverage to millions of Americans who currently are uninsured or underinsured.
Most of the aggressive healthcare payers will not only be planning to meet the regulatory compliances of the ACA, but at the same time they are going to determine how they can capitalize on what’s estimated to be a $33 billion growth opportunity in this individual market.
Consumers have a certain expectation when it comes to customer service. The entire member experience from sales and enrollment to customer service and care management really needs to be coordinated around the various touch points of communication—whether it’s mail, email, mobile or web presentment. Insurers who lack the infrastructure to support this depth of member-experience focused strategy may find themselves out of the competition.
For payers who embrace this, making sure the enterprise is equipped to handle the increase in customer traffic in terms of work volume and customer interactions is going to become a major differentiator. Payers need to be willing to transform their businesses from the traditional transactional model to a model that’s built around individual relationships. The opportunity there is growth, but the challenge is having the systems in place that can provide outstanding member experience across their organization in order to capture new members and retain them.
From an IT perspective, this means they’re going to be evaluating and adding new technology in order to support this changing business model and the growth associated with it. Insurers are moving away from focusing on efficiencies they have been doing for several years to being customer center focused—all in a profitable manner.
This transition to a member-experience focus is a huge strategic shift. It’s going to take considerable time and investment from the payers because it is a big change from how they operate today.
Health insurance is an abstract product, and that main connection to your members comes through communications. The welcome kits you send along with the statements, benefits and coverage, explanation of benefits, and the calls from the call center are really how members form their opinions on their health plans based on what they’re receiving, hearing and seeing.
It’s not anything that’s tangible. In many healthcare plans, this member correspondence has been a departmental approach, so they might have a homegrown system in one area or be using Microsoft Word. Maybe they’re just using generic form letters, which is another area.
However, what it comes down to is they are not taking a holistic view of the member. These systems are inefficient approaches, and they considerably hamper the healthcare industry’s ability to grow and maintain membership—not to mention the severe impact to their bottom line. Often what results are high error rates in the correspondence being sent out, or they may have poor response times back to their members.
From a marketing perspective, there is no brand consistency when there are all of these small areas doing communications, and of course, the IT staff is already overburdened. They maintain all of this content and maintain the systems. To improve that member experience, health plans need to take an approach to look at member correspondence as a strategic imperative.
It’s not just a call center. It’s not just regulatory compliance. These plans need to increase their member experience from a rendition and growth perspective by improving these communications. Creating better personalization of the content, reducing or eliminating the errors being sent out and offering multiple communication channels (not just print but by email, text or web presentment in the manner that the member wants to receive the information), responding faster to their members and having a consistent look and feel in providing information that members find readable is critically important.
An enterprise correspondent solution can really help plans—not only to accommodate the potential growth and efficiencies that are there, but to provide a vastly better customer experience.
The challenges these insurers will face as a result of the Affordable Care Act will impact their organization in ways no other development in recent years has done. If insurers fail to properly prepare for these challenges, they place themselves at risk in an already competitive marketplace. By delivering a more focused member experience, companies can effectively confront the changes set to happen this year, improving enterprise operations and optimizing their customers’ experience.
(Lori Gelter is program director for Cincom Document Solutions. She has been with Cincom for over 20 years. As program director, Gelter is heavily involved in the strategies, sales, and implementation of document automation solutions at insurers around the world. Lori holds a BSBA in Accounting and a Master's Degree in Information Systems, both from Xavier University.)
- Electronic Chat with Todd Greenbaum
- Martha Notaras: The “Outsider” with an Amazing Inside View
- ProSight Direct Offers “Effortless Insurance for Today’s Professional”
- Electronic Chat with Larissa Tosch
- Martha Notaras Will Join ITA LIVE 2019 as a Keynote Speaker
- Five Things to Consider When Evaluating Your Cyber Risk
- ITA Pro Magazine, January/February 2019
- Major Ransomware Attack Could Hit U.S. with $89B In Economic Damages
- ITA Announces 1st of Three Keynote Speakers at ITA LIVE 2019
- Electronic Chat with Jeroen Morrenhof
- Legacy Systems Are Dead. Really? Don't Count On It.
- Now Accepting Nominations for the 2019 ITA Bridge Awards
- It's time to register for ITA LIVE!
- Registration is Now Open for ITA LIVE 2019!
- What to Expect from a Digital Experience Platform Implementation
- ITA Pro Magazine September Edition is Now Available
- It's National IT Professionals Day
- Save the Date for ITA-LIVE 2019
- OneShield Software and UrbanStat Work Together to Improve Real-Time Analytics and Risk Decision-Making
- ITA LIVE 2019 - SAVE THE DATE!
- Insurance Technology Association Announces New Editor-in-Chief
- August 2018 Edition ITA Pro Magazine is Now Available
- Enterprise Architecture in an Agile World
- Top 10 Tips for Securing Your Mobile Devices and Sensitive Client Data
- Industry Insight: 4 Global Insurance Trends in Digital, Data, Content Services and Security
- Diving Deeper into Prioritizing Your Strategic Digital investments
- Why Content Rules
- How Mass Personalization Will Open the Small Business Benefits Market
- At Year End 2017, Will Your Organization Be Protected from Cyber Risks?
- Do Insurance Bots Dream of Mitigating Risk?
- Conditioned to Respond
- Managing & Mobilizing Insurance Data in a Connected World
- Race to the Finish Line
- New Tools, New Opportunities in Claims
- ITA LIVE: Reaching Insurance Industry Crossroads
- Advice to Insurance IT Leaders: Keep Your Eye on the Ball
- New Date, Venue for ITA LIVE 2017
- Guidewire Makes Major Push to Small and Midtier Market by Acquiring ISCS
- Insurance Disruption is Happening Right Now
- Insurity Adds Strategic Investment Partner, General Atlantic
- Beyond Transformation: The Convergence of Finance, Risk, and Actuarial Functions
- The Rapid Evolution of Consumer Protection Regulation
- Talent Hunt: Finding, Attracting, Retaining Top People
- Insurers Flexing Their Distribution Models
- Technology Driving Disruption in Insurance
- Fear of ‘Next Bubble’ Challenges Life, Annuity Carriers
- Technology Allows Commercial Lines Insurers to Stand Out
- Single Sign-on Viewed as Biggest Tech Challenge for Agencies
- ISCS Observes 20th Anniversary; Scurto Predicts Major Changes Ahead
- Policyholders and Their First Impressions
- Progressive Making Progress on the UBI Front
- High and Dry: Insurers Search for Disaster Recovery Plans
- Insurers Sign The (Un)Dotted Line
- Reflections of a Retired Insurance CIO
- Mobile Device Management Just One Answer to BYOD Issue
- Lessons from GEICO and Progressive on Winning the Critical Buying Stage
- You Are a Target for a Cyber Attack
- Web-based Systems are the Next Evolution in Claims Technology
- Gaining a “Wow” Experience from Web Users
- Time to Shift from Business/IT Alignment to Business/IT Alliance
- Healthcare Insurers Changing to Consumer Model
- Organization is the Key for Selecting Software Vendors
- Analysts Expound on the Needs of the Mid-tier Insurance Market
- Finding the Cure for Obamacare’s Website
- New Software Solutions Benefit Insurers on the Inside and Outside
- Products, Market Impede Investment in Systems for Life Insurers
- Combatting Cyber Threats: Predict, Prevent, Persist
- The Future of Telematics Heads Beyond Insurance
- The Shame in Cyber Security Lapses
- Building Policy Administration Systems for the Future
- Insurers Look Into The Eyes of Their Policyholders
- It’s a New Dawn for the ITA
INSURANCE IT NEWS
- Unique partnership between VMSolution and FRISS enables fast claims process
- Roost Joins the IoT Insurance Observatory
- Appalachian Underwriters launches world-class billing and payments offering (through Input 1)
- National Life Transforms Customer Experience Program with Cognizant
- Insurers Driving Real, Measurable Value from Digital Investments
- Insurers Embracing Digital Claims Payments, Says Novarica
- Majesco and DataRobot Partner to Bring Integrated AI/Machine Learning with Majesco Solutions to Customers and the Insurance Industry
- Stonetrust Commercial Insurance Selects Insurity’s Cloud-hosted ‘Workers’ CompXPress Suite’ to Improve Operations and Customer Experience
The Email Chat is a regular feature of the ITA Pro magazine and website. We send a series of questions to an insurance IT leader in search of thought-provoking responses on important issues facing the insurance industry.
ITA LIVE 2019
The tide is up! It's time to register for ITA LIVE 2019, our annual educational and networking conference! Our theme is "The InsurTech Revolution: Cutting Through the Hype." and we'll be bringing in a torrent of industry thought leaders, amazing insight and wonderful perspectives on the world of insurtech and its impact on the insurance landscape.
ITA LIVE 2019 will present real-life examples of true startup technologies that are helping insurers gain real advantage -- and a competitive edge -- in the marketplace. We’ll highlight the more successful InsurTech partnerships, while offering case studies that demonstrate exciting innovation and cutting-edge techniques impacting all aspects of the insurance ecosystem.
Ride the wave to LIVE 2019. Sign up today! We look forward to seeing you in May, 2019!
BLOGS AND COLUMNS
You have surely heard it said that small businesses are the growth engine for America. Today, the phrase has a special ring to it for benefits... READ MORE
With stagnant growth and lingering low interest rates, the life insurance industry faces a challenging future... READ MORE
Finding insurance carriers willing to write commercial lines risks has always been a challenge for producers... READ MORE
As Guidewire Software prepares for the start of Connections, its 11th annual user conference that begins on Nov. 2, Brian Desmond, chief marketing... READ MORE