Health Plans Face Under-Informed Consumers

Many commercial payers are grappling with the challenge of developing direct relationships with individual customers who lack knowledge about the new health insurance exchange markets and confidence to make purchasing decisions.

It makes me nervous to think that the success of an enterprise is dependent upon changing the way people think or habitually act. Counting on a pair of commercial partners to make fundamental change can be downright panic-inducing.

With the rising profile of the consumer in the health insurance marketplace, health plan members and insurers alike face changing roles, with high costs for taking risks that end in failure.

Wanted: A Self-sufficient Consumer
Whether a person has never had health insurance or has had a policy for decades through an employer, the growing number of coverage options available makes becoming an educated consumer essential. In the case of health insurance policies with high deductibles and other out-of-pocket expenses such as the catastrophic coverage offered on the new public exchanges, consumers face high-stakes choices.

After making her presentation during the final general-audience session of last week's AHIP exchange forum, Cammie Blais, a top public exchange official in Colorado, told me one of her prime goals for the 2015 enrollment year is improved consumer "self sufficiency." The Connect for Health Colorado CFO says she is aiming to strike a balance between a fully self-sufficient consumer and the concierge model, where consumers are guided through the process of obtaining and maintaining health insurance.

And, Blais told me that Connect for Health Colorado hopes to continually improve its website to provide consumers with "more robust tools to inspire confidence in the decisions they have to make."

With outreach and education funding for the public exchanges certain to decrease over time, Blais says creating more self-sufficient consumers is critically important to sustaining the new exchange market. Citing the need to reduce in-person customer service as a financial necessity, she says the Colorado exchange team is focusing on a key question: "How do we make the technology do some of the heavy lifting for us?"

It's 'A New World'
For decades, most health plans have relied on agents and brokers to handle the customer service side of their business. With consumers considering options to employer-sponsored health insurance such as policies on public and private exchanges, retail was a hot topic at last week's AHIP exchange forum.

Billing is a relatively easy way for health plans to build relationships with individual consumers, several AHIP forum speakers said. Billing helps a health plan establish regular contact with members, said Mark Waterstraat, chief strategy officer with Omaha, Nebraska-based Benaissance. "Every month, they see you," Waterstraat told one of the small groups of forum attendees who had signed up for seminars that included lunch right before the forum kicked off. "It wasn't a Google search that brought the consumer to you on a one-time basis."

He says one of the keys for health plans offering policies on exchanges is to make is easy for members to pay, including checks, money orders, credit and debit cards, online payment and call centers. "Different people pay in different ways," Waterstraat said.

Kevin P. Kelly, a principal at Deloitte Consulting and midwife to the apparently successful public exchanges in Connecticut, Kentucky, Rhode Island, and Washington, says exchange officials literally have no business billing health plan members. Insisting carriers that should always handle billing, Kelly says, "Push it to where it belongs – to people who are really good at it."

The consumer was front and center in a conversation I had Tuesday with the director of J.D. Power and Associates' healthcare practice. We were talking about J.D. Power's 2014 Member Health Plan Study, which was released Monday. Based on data collected in December and January, the report gauges consumer satisfaction with US health plans by region and by markers such as trustworthiness and communication with members.

Rick Millard, who holds several university degrees including a doctorate in clinical psychology and an MBA, says the 2014 consumer satisfaction study shows health plans understand the importance of connecting with consumers but there is a learning curve to climb. "Plans are trying to figure this out but it's a new world and it takes time," he told me. "I'm not sure they truly understand how to take on this issue… but hopefully they will continue to make strides."