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Customer Experience and Design

2016 Connected Health Trends: Mega Merger Meets Member Experience

Mega-Mergers, Mega Concerns for Patients
Creating the Connected Health trends report requires us to, among other things, mine through approximately 30,000 news coverage points per year. Circulating through the news in 2015 we found much on the topic of the new world of health insurance. Big news on this front was the industry consolidation under a string of potential mergers. We have Aetna and Humana, Anthem and Cigna, and UnitedHealthcare perusing their options as well. However, this story is not limited to the world of big plans. Smaller and mid-size plans are also moving with this consolidation trend.

From a Connected Health standpoint, we want to know how this health insurance mega merger will impact the member experience. There are many postulating on what this will mean from a cost of health plan standpoint. Some feel that the mega merger will increase the negotiating position of a now smaller group of insurers and, therefore, increase the cost of health plans. Others believe that the cost consolidations found in mergers will actually decrease the cost of health plans. Fewer are keeping their eye on the barriers of entry into the marketplace and the possibility for the “Geico for healthcare” entering the health insurance world. However, we are interested in the changes that will occur beyond the mechanics of the health insurance exchange. What impact will this mega merger have on the actual member experience?

In the short term we can make some assumptions about investments in member experience slowing or, in some cases, halting. In the short term there will be a hesitance to invest until merged systems can be combined. This is the big barrier of entry that big health insurance is leaving open for new entrants in the meanwhile. If, in the extended time it takes to make these mergers happen, new entrants can join to create a better member experience, then we could see some pretty dramatic shifts in the marketplace.

Given that in the post Accountable Care world many insurance products look very similar, health plans need to look for differentiation strategies that keep members engaged in their care as well as help them make sound choices from a cost of care perspective now that more of the decision making power is in their hands (and wallets). Here are a few favored options:

  • Wellness Strategy: One differentiating strategy that is gaining steam is the wellness strategy. Here we find insurers, like Humana with their HumanaVitality wellness program, creating digital tools to enable their member’s health. Humana more recently announced two new weight loss-focused partnerships with Weight Watchers and Kurbo Health to extend this strategy.
  • Member 360 Strategy: Here we are ripping pages from the retail industry playbook. We are using the volumes of health plan data and tying them together in a consumer centric data warehouse that we can then use to unify the member experience across all touch points, identify and focus on loyalty programs for the most valuable members, target members through personalized offers, create predictive analytics programs to enable cross-sell/up-sell, and, in the end, create the closed-loop analysis and continuous optimization.
  • Telehealth Programs: The industry finds itself in an interesting space from a telehealth perspective. While healthcare providers are finding difficulties around reimbursement, health insurance companies are offering telehealth programs themselves in order to increase revenues and decrease care costs in instances where members would typically use, say, urgent care or the emergency room. Last year, health plans such as UnitedHealthcare and Horizon Blue Cross Blue Shield of New Jersey were some of many insurers increasing their telehealth investments.

Regardless of the strategies we find health insurance plans using around member experience, the truth of the matter is that member experience will be in sharp focus in the year to come.

Health Plan Mega Mergers Impact Member Experience is just one of the trends we explore in our new guide, The Definitive Guide to Connected Health 2016: 10 Trends You Need to Know. Download the guide to see where this trend falls and to discover the other Connected Health trends healthcare executives must be aware of. In the guide we also provide insights to help organizations not only survive – but thrive – in the age of consumer-driven healthcare.

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Melody Smith Jones

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