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  • admin 9:52 am on April 15, 2015 Permalink
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    Health Care Pro’s! It’s Half Past Enrollment: Do You Know What Your Members are doing? 

    As the health insurance industry moves closer toward embracing a retail-oriented, consumer-focused business model, it is crucial to know as much as possible about members both before and after enrollment. Health plans that are able to anticipate and execute on interventions for better service, retention, sales and management of health, will yield the highest gains in this new consumer-focused business model. A data-driven strategy empowered by insights around individual and population needs can improve the experience for the member and improve the health of the member population while also minimizing cost. If you think about it, having a customized service for health insurance is a win-win for all parties involved.

    I recently attended a conference focused on consumerism for health plans. Most of the topics were aligned to the Accountable Care Act products and enrollees. There was a separate track for Medicare Advantage and Medicaid. As I listened to panel members discuss their approach to having a better marketing strategy or a better service strategy, the key point was focused on the best use of data.

    One member was proudly talking about his health plan’s efforts with the Private Health Exchange. He mentioned that one of their biggest challenges was that they knew nothing about these “new members.” I raised my hand and asked how many members were previously enrolled with the plan. Answer: high, actually 90%. The problem was that the reporting was based on “group level” information and thus they were unable to relate it back to the individual. So the history of a member’s risk and stratification is missing. Think about the ramifications — as they apply to the missed opportunity for health engagement, continuation of health coaching, and revenue risk.

    Consumers are free to select the health plan that meets their healthcare needs in several markets; Medicare Advantage, Medicaid, the Healthcare Public Exchange and Private Exchanges. Integrating consumer data with prospect lists and current member information reveals patterns that can be rolled up into segments of consumers. Marketing campaigns can be personalized — if the data is integrated at the consumer level — so that the offer (sales or health intervention) is tailored and the messaging is more effective to the consumer.Health-Insurance-011Effective communication strategies benefit the entire life cycle of consumer engagement from sales and marketing to onboarding of new members into appropriate health and wellness programs. Strong communication also helps avoid dissatisfaction due to changes in the provider network or formulary, and helps enable retention for those with a high consumer lifetime value, plus consistent clinical intervention to avoid gaps in healthcare. Effective data driven communication strategies will improve the bottom line.

    Health plans have multiple channels in which to market their products; the public health exchange, private health exchange, retail stores, in-house telemarketing agents, external agents, kiosks in retail malls or stores, mail and more. Integrating marketing campaign data with sales channel activity provides insight about which campaign is attributed to the consumer that’s purchasing insurance. Relating the consumer to segmentation information helps to make the next campaign smarter.

    Understanding the channel preference of each individual and the attribution between the campaign and sales channel, assists the health plan in understanding the effectiveness of campaigns and enlightenment around how segments of consumers behave. Is it true that baby boomers prefer contact via phone? That is a hypothesis that can be proven by analysis. An effective segment might be a segment of one, where it makes sense and create campaigns driven by the data and the behavior of the consumer.

    Once a member enrolls, what are all of the interactions that occur between the member and health plan? A member, as a consumer, can vote with their feet during re-enrollment. What plans are in place to understand the member experience from sales, to enrollment, to service, claims submission and health management, if applicable?

    Integrating all interactions that a member has with a health plan and analyzing patterns of behavior can provide insights to improve experience and the bottom line. Examples include: what activity leads to complaints or dissatisfaction, predict which members are on the path to multi-skeletal surgery, understand which path of on-line activity leads to a purchase of insurance, predict which members are likely not to adhere to medications required to control chronic conditions. All of these insights can be applied to improve business processes or target those members where an intervention will result in behavior change to improve health or reduce costs.

    Some new members, especially on a private exchange, are not really new members at all. Some are loyal members who were enrolled in a group product — who are now shopping and interacting with the health plan as a new consumer. Amazingly, some health plans are working with a blank slate because they are unable to relate prior claim history with current experience in order to understand the health condition(s) of new members.

    In an era of the 3 R’s, a health plan that can’t integrate all data related to a consumer stands to lose revenue in state risk pools, and misses the opportunity for early engagement into health management programs. Developing a master person index and integrating all information is critical to bridge data between products for understanding a member’s clinical profile.

    A health plan today needs the ability to identify individuals and households across all lines of business and all products. A single consumer level identifier is necessary in order to compete.

    I’m sure members who were enrolled in a group product and now enrolled as individuals in the private exchange do not think of themselves as new members. If fact, they have an expectation that the health plan already knows and anticipates their needs. A health plan should know the customer’s current and past health conditions, their preferred method of communication, whether or not they comply with health protocols, whether or not they are on the road to a more severe health condition — and if they are likely to recommend your insurance product.

    So while 2014 was the year of acquisition; 2015 is the year of retention.

    What do you know about your “new” members and who do you want to actively retain? In an era where retention will become increasingly important, understanding causes of disenrollment, which members are likely to disenroll and a consumer’s life time value will become an important factor in deciding retention strategies. It’s half past enrollment, what do you know about your members?

    Rose Cintron Allen bio sized photo

    Rose Cintron-Allen is the Practice Lead Healthcare Consultant for Teradata with over 20 years experience in the health and life insurance industries, with more recent experience in the managed pharmacy industry. Rose’s expertise is in developing decision support solutions for the healthcare industry and helping organizations meet their business challenges through technology solutions.


    The post Health Care Pro’s! It’s Half Past Enrollment: Do You Know What Your Members are doing? appeared first on Industry Experts.

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