Keith Loria August
1, 2019
Employers and
consumers are looking for new solutions to the healthcare challenges being
faced today, including the complexity of benefits, gaps in care and rising
costs. That mindset has caused leading payers to think outside the box in their
attempt to win new customers.
A sound strategy
built around innovation and customer care is winning out as payers try to
ensure that not only do they keep the customers they have, but bring in new
ones to achieve success.
Making connections
Tom Wicka, CEO
and co-founder of NovuHealth, which serves more than 40 health
plans across the U.S., says regardless of the product segment, any payer’s
success depends largely on its ability to engage consumers.
“Few payers have
mastered consumer engagement—historically, they haven’t had to,” he
says. “But with the growth of consumerism in healthcare and the shift to
value-based care, building meaningful connections with consumers has become
imperative.”
Therefore, to remain
competitive, he says, health plans need to take a page from leading consumer
brands and adopt the consumer engagement best practices they have already
perfected, including user segmentation and propensity analytics, personalized
content and communication channels, and rewards that not only inspire action
but build long-term trust with members.
Christine Paige,
chief marketing executive of Kaiser Permanente, an integrated managed care
consortium based in Oakland, California, says one of the biggest changes over
the years is the move toward greater personalization.
“There’s been an
increased usage of what people have told us about their interests and
preferences to make the information and dialogue more relevant,” she says.
“That is different from the one-size-fits-all communication that used to
prevail.”
Choosing a focus
Nick Brecker,
president, specialty business for Anthem Blue Cross Blue Shield, an
Indianapolis-based health insurance company, says the company’s strategy
focuses on offering leading products combined with an industry-leading approach
to “whole person healthcare.”
“While our specialty
products (dental, vision, life and disability, and voluntary supplemental
health plans) are available on a stand-alone basis, they can be packaged with
our health plan products to better coordinate care, which results in more
efficiencies, better health outcomes and bigger savings,” he said. “This is
made possible by Anthem Whole Health Connection. This unique approach to a
person’s whole health connects claims and clinical data to identify and impact
gaps in care, lowers costs, and delivers a simpler healthcare experience to our
consumers.”
He notes healthcare
is inherently personal and Anthem Blue Cross Blue Shield’s (Anthem) Specialty
business is focused on helping to make the delivery of healthcare as
personalized and tailored as possible for every consumer.
“Our integrated
approach to ‘whole person healthcare’ means we have the opportunity to help our
consumers better manage their health conditions through early intervention and
by closing gaps in their care,” he says.
John Nicolaou, a
healthcare payer expert at PA Consulting, says payers need to acquire
customers from their competitors in order to grow organically.
“The biggest focus we
are seeing is on brand and service differentiation rather than product or
benefit differentiation,” he says. “An example would be tools to help predict
out-of-pocket payments, or to encourage and reward healthy lifestyle behaviors
to help members manage their health costs.”
There are also
similar avenues for employers to better manage the cost of care, including
improved claim analytics or to reward healthier behaviors.
“It will be critical
to make these brand and service differentiations attractive and relevant and
valuable for members, rather than gimmicks for payers,” Nicolaou says. “Key to
this is to understand not just who their members are, but rather to understand
their member relationships with payers and the health system overall to find
ways to differentiate.”
Chris Seib, CTO and
co-founder of InstaMed, a healthcare payment network in
Walnut Creek, California, says payers need to focus on improving the member
experience and look at the consumer experience in other industries to
understand the benchmarks.
“According to
the Trends in Healthcare Payments Ninth
Annual Report, 86% of consumers want to make all of their healthcare
payments in one place,” he says. “Payers can help consumers meet this need by
offering payment capabilities within their member portals. Payers can take the
friction out of healthcare payments and increase member satisfaction, increase
member portal traffic and tool utilization, and accelerate payments to
providers from members.”
Lissy Hu, CEO of
Boston-based CarePort Health, says payers leverage the
CarePort care coordination platform to drive financial and quality outcomes.
She explains specific
opportunities for payers to leverage CarePort include: guiding members to the
most appropriate level of care, enabling ED diversion, tracking patients in
real time to power effective transitions of care, and increasing first submission
success around post-acute authorizations.
“CarePort’s vast
provider footprint enables payers to most effectively and efficiently achieve
visibility into member utilization and progression across settings of care,
helping to drive better quality and cost outcomes and patient experiences,” Hu
says. “Nearly 1,000 hospitals and more than 20,000 post-acute providers use our
platform for comprehensive care transition work flows including utilization
management, discharge planning, care coordination, tracking outcomes, and
refining work flows.”
Direct to employer
program
Stewart Schaffer,
co-founder and managing partner of CSuite Solutions, a
Tampa, Florida-based healthcare advisory firm, notes employers very much want
to work directly with healthcare systems to provide healthcare coverage for
their employees and healthcare systems also want to work directly with
employers to do the same.
“Both parties already
know the many potential advantages of working face-to-face with each other so
the market is prime for direct-to-employer group health plans,” he says. “All
that is missing is the infrastructure, technology, and expertise to make it all
happen. Our sales and marketing strategy is simply to tell the story of how the
combined expertise and experience of CSuite Solutions and KBA have partnered to
make this all happen.”
With that in mind,
when looking to add customers, CSuite Solutions focuses on risk management,
plan designs, claims processing, open enrollments, case management, care
coordination, proactive health management, and overall customer service.
“You have to take an
enterprise approach to delivering these programs. This is not just a network
contracting exercise. By this I mean that healthcare systems have to look at
these programs like they would going into a new business that is quite
different from what they do now,” Schaffer says. “The simple thought that
having employers as customers is a whole new world for them has to be accepted
throughout the organization. We understand and facilitate cultural acceptance
of these programs across the enterprise so that successful outcomes can be
assured.”
Keith Loria is an
award-winning journalist who has been writing for major newspapers and
magazines for close to 20 years.
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