As consumers take on more healthcare cost and decision-making, health plans must provide more service and education to avoid the financial pitfalls lurking in the new payment models
Fall is the time for many companies to hold open enrollment for their employees and, as many are realizing, consumer-directed healthcare with high deductible health plans and HSAs are here to stay. Just as employers replaced pension plans with retirement savings plans, the number of companies implementing a similar cost-sharing shift with health plan coverage is increasing each year.
What does this mean for health plans and consumers?
For health plans, this change means greater engagement with consumers. Marketing, sales and service for individuals is more expensive than traditional, employer-focused efforts. That means health plans will either have to become more efficient, or face rising administrative costs. Without an effective Customer Relationship Management (CRM) system to streamline communication strategies, plans will have a difficult time meeting the ACA-mandated, minimum medical loss ratio standards.
For the consumer, it means greater financial responsibility, requiring more decision-making on their part. That, in turn, means they will have a greater need for education, information and price transparency.
An opportunity for lower costs, but pitfalls lurk
Employees have traditionally relied on their employer to provide health plans that require only modest copays for physician visits and prescriptions. Consumers didn’t have to worry about the actual cost to go to the doctor, even for minor things that may not have actually needed a doctor’s care, such as a child’s cold. It was simply a matter of a $15 or $20 copay. Many in the insurance industry feel HMOs and copay-based PPO plans like these effectively took price sensitivity, and perhaps personal responsibility, out of the healthcare equation. This shift away from copays to a model that places more financial responsibility on the consumer is likely to encourage more careful use of resources and help drive down medical spending. Ideally, having “skin in the game” will push consumers to ask more questions about the cost of tests and treatments and whether a procedure is really necessary. This may result in smarter and more well-informed medical decisions.
But there are downsides, too, with negative consequences for both insurers and consumers. If patients fear they can’t afford to pay for valuable treatment and skip necessary treatment and care in early stages of chronic conditions, the end result will likely be a much higher price tag (for both consumers and health plans) down the road. Also, many medical crises can’t be avoided or budgeted for, and high deductible health plans may leave consumers with a large, uncovered medical bill. The resulting financial stress can leave consumers angry and feeling that their health plan has let them down. And health plans have just as much “skin in the game” as consumers when it comes to helping their customers make wise coverage and care decisions. To avoid negative health and financial consequences, health plans will need to provide consumers more guidance in choosing the appropriate plans as well as the right engagement tools to guide them throughout their healthcare journey.
A new model for customer engagement: The advanced CRM system
Developing relationships with today’s buyers requires marketing efforts that result in conversations with consumers and provides needed education and tools to help them navigate the healthcare system. Today’s healthcare consumers expect personalized communications, consistent multi-channel interactions and efficient tools.
To meet customer needs and expectations while keeping administrative costs within the mandated standards, health plans will need an advanced CRM system. CRM tools help with:
- Capturing leads from digital campaigns
- Acquiring and retaining customers
- Driving more personalized experiences to consumers
A well-planned and implemented CRM system can enable a health plan’s marketing and sales teams to collaborate on their customer conversations at every stage of the customer lifecycle. This will allow the health plan to better serve customer needs for information and cost transparency, while also increasing responsiveness and a sense of personal attention. And that will increase consumers’ satisfaction with, and trust in, their health plans.
A good CRM system can also help health plan executives get a more accurate picture of their prospect and customer base and help customer service teams track customer questions. This will allow the health plan to better anticipate the need for outreach, education, and to adjust their systems to proactively provide the answers members are seeking.
If your health plan doesn’t have a modern, advanced CRM system with automation tools, it’s way past time to develop a strategy and make the investment. A solid strategy will allow plans to cut administrative costs, improve the customer experience and build long term customer relationships to succeed in the evolving healthcare marketplace.