Are you making the most of it?
Yes, I said Exchange, but will refer to them as Health Insurance Marketplaces (HIM). I know many have been working to get ready for the October 1st open enrollment, but have you been doing everything you can? In the past, sales of individual policies haven’t amounted to more than a single digit percent of the population and your book of business. With the opening of state and the Federal HIMs, everything changes for the individual policy product, moving it from “step-child” status to mainstream. All are focused on this and have begun soliciting, at least in the manner their respective exchange allows, and getting ready to service this new channel. While all eyes may be on the rollout of the HIM, the real opportunity for participating payers is on how they engagement with these prospective customers, pre and post-sale.
HIMs provide for the external event necessary to get the internal support and commitment (financial and otherwise) to take a way of doing business and move it to the next level. There are two practices that are candidates for this step change. The first deals with engaging and selling to this new channel. The traditional approach, and 
subsequent cost to acquire, has been mostly indirect, working through brokers, consultants and agents, employer HR, and state governments. The apparatus and effort have substantive costs and a lengthy sales cycle. Making things more challenging, retention isn’t assured by satisfying the many members, but the decision maker and the broker/agent. So what’s the opportunity? Well, you get to really do marketing; direct consumer marketing in fact. As such, you need to rethink and revisit how you market, sell and service your products to this new channel. Doing so requires a new approach, with the use of a Customer Engagement Platform, supported by content management, digital marketing, robust CRM capabilities, the ability to target consumers across a whole spectrum of means and devices, and the need to identify the impact to the current operational norms. The last item involves the detailed review of standard operating procedures (SOPs) and basic concepts. For example, a lead or prospect is not a member, and as such, you can’t depend on established member SOPs and systems. This type of consumer engagement falls into a new area we refer to as Connected Health. In the world of Connected Health, it’s recognized that the new norm for engagement is typically via the web, internet, smart phones, PCs, social media outlets, texting and other devices.
The second, potentially greater and more impacting, opportunity is to revisit the existing solution used to service members. As I alluded to above, you still need to continue to execute on the current service norms, but those norms need to be added to and enhanced for this new world. Given the traditional sales dynamics mentioned earlier, the current “member” services platform and process tends to lean more toward a ticking of the proverbial box in order to sell to and win the block of business from the decision maker/broker/agent combos. In terms of basic expected features, as long as someone can look up a provider, check on a claim, maybe refill their mail-order prescription, it was ok. That won’t work with the individual buyer. To ensure your retention level is high/churn is low, you are going to need to enhance your member services, maintaining continuity with the new consumer engagement branding, engagement and activities. This change event also provides another opportunity to up your game. In the spirit of this broader consumer engagement, these member services can be enhanced. It’s time to move from passive, like an email that says “hey, you have a claim,” to something much more dynamic. Through risk stratification, the use of business intelligence, consumer personalization, the notion of consumer engagement begin with the initial sale, carries on through to the service “side.” For example, if a member made a recent visit to their primary care or family physician, as evidenced by a claim, you can actively review the claim for diagnosis and treatment, say note the need for a specialist and reach out to them with a suggestion for specialists that live in the area. Or, when the member “signs in,” dynamically display content and interaction based upon their profile and utilization. You have the opportunity to actively engage with the member creating a better experience for them, not to mention a healthier one and by leveraging technology and information, provided for a lower cost to serve.
So, the Healthcare Insurance Marketplace is coming! Are you ready to make the most of it?
