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Healthcare Insurers Changing to Consumer Model

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.)


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