Customer Experience and Design

Member-centric Care: Missing a Core Team Member

In my last blog post I asked if we have missed a core team member in member-centric care. My answer: In Sales there are the Health, Life and Supplemental Insurance Agents for employers and members that are responsible for mentoring members on plans, eligibility and benefits as well as understanding claims.

These individuals make a commission long after the initial open enrollment period of meeting with individuals for private health insurance. Yet, their commission should somehow be based on or changed due to member continuation and satisfaction.

The question to the Payer is what role, responsibility, and payment plan you want for the Insurance Agent and/or Broker in today’s environment and moving forward. Are they to become order takers? If they are paid commissions monthly after the enrollment, do you not think they should be mentoring the member through these rapidly changing times in order to encourage urgent care vs. emergency room? You may want to encourage health fairs for HSA members to compensate for the lost cost with high quality annual physicals so less money is taken out of their pockets and more is kept in their HSA account.

Are we looking at a clinician and non-clinician relationship as seen today in care management; that is non-agent (order taker) and agent? Would the latter be in-house or all contractors? Would the broker be a service or partner in an ACO?

What will the Insurance Agent/Broker role be in an ACO? We still need that first human contact for sign-up and support for all the questions after the enrollment.

Should Insurance Agents/Brokers become contractors to Payer or to an ACO? Remember they are licensed within the state which should be leveraged.

If you are a CEO, does your BPM include Marketing/Sales and the role/responsibility of Insurance Agent/Broker? How will this be addressed with the ACO? What can be done today to leverage, incentivize, and track performance not on enrollments?

I will plan to blog more about this since I have been an insurance agent for employers and private citizens and provided the following suite of products: Multiple Healthcare Payer Plans, Colonial Life Supplemental Products, Life Coverage, etc. I know the ins and outs of pharmacy too.

In addition, I have worked as project/product manager for a payer/carrier in Marketing/Sales and delivered on HSA, HRA, Old to New PBM and Enhancements to HMO, PPO, POS, etc.

My assumption is that we have not gone far enough upstream with this process and role for Member-centric Care, especially with an ACO. We have worked on Payer and Association of Providers (networking) contracts and structure.

Most of my readings and exposure has seen a focus on the middle of a collaboration and rather ignore the Agent/Broker, which I think is a missed opportunity for member persistency and satisfaction for successful Member-Centric Care.

I am looking forward for your thoughts on business transformation with sales and Insurance Agents/Brokers.

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