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Putting the Consumer in Charge

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Health plans must prepare for changing relationships with members.

This is the final in a three-part series of articles profiling the health plan of 2020. This month, we look at how health insurers will need to change the way they interact with members.

In our earlier installments of this series, we have looked at how health insurers may need to change their relationships with providers and employers by 2020. There are surely barriers in those relationships, but those stakeholders at least understand the healthcare system.

Consumers are a more complicated issue. The relationship between insurers and their members has been traditionally cool—at best. On the positive side, consumers see health insurers as the faceless entity that pays for their care and, more negatively, the companies that reject paying for care.

The consumerism movement in benefit design has shifted more costs and decision-making to individuals. By 2020, members will have even greater responsibility for their healthcare. Members will need to become better healthcare consumers.

Health insurers see the transformation coming, and leaders are preparing.

Paul Markovich, executive vice president and chief operating officer at Blue Shield of California, the San Francisco-based insurer with 3.4 million members, says health plans should continuously work to improve communications with members. Health plans must become a trusted resource to support and advise members' health decisions.

"To do that well, I think you'll see a lot of plans doing what we're doing—piloting new tools both online and offline to communicate with members in the way they most want to communicate," says Markovich.

"Blue Shield is in the middle of a major, multiyear project to upgrade our core systems and business processes. The changes we're now making will enable more automation, facilitate access to care, and provide better, faster service. This will establish the technical foundation for our future," says Markovich.

He says the current technologies health plans are using to reach members, such as social networking platforms, will expand to advanced remote monitoring devices, including integrated, portable electronic medical records.

"Our industry has been talking about EMRs for a long time, and I think that by 2020 we'll finally see this technology spread out and become the new standard. EMRs will allow health plans and hospitals to provide far faster, more accurate service. I think we'll see fewer medical errors, better quality performance data, better identification of trends, and a host of other benefits," says Markovich.

In a world with more consumerism, health insurers will need to learn about the member experience by "walking in their shoes," he adds. Individualized benefits and plans bring about both opportunities and challenges, he says.

Sander Domaszewicz, principal at Mercer Consulting in Newport Beach, CA, says insurers have already started preparing for the change by hiring experts from traditional consumer markets to learn what motivates consumer buying habits. Insurers have also looked to gain market knowledge through buying other companies.

CIGNA, the Philadelphia-based health insurer with more than 11 million members, has been working on consumer-oriented technologies that enable members to improve their health and healthcare experience, such as online tools to help members manage their health.

"This includes upgrading online services to make it easier for people to find providers of the care they need, receive accurate estimates of treatment costs and plan benefits, manage their healthcare expenses, reconcile their costs, and pay their medical bills online," says Chris Curran, director of corporate communications at CIGNA.

Curran says CIGNA is preparing for the change by simplifying healthcare for members. An early step in this process is that CIGNA created a "Words We Use" glossary for employees, which translates industry terms into easier phrases that consumers understand. This work includes redesigning all customer communications materials from enrollment guides to explanation of benefits.

Such changes are quite different from the health insurers of the past two decades, but in a consumer world, health insurers will need to follow other industries in revamping the way they do business in 2020. That will mean overhauling how they interact with consumers, learning from industries already providing those services, and purchasing companies that are offering products that could fit well under an health insurer's umbrella.

"To some degree, they have to reinvent themselves," says Domaszewicz.

Les Masterson

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