by Bobby Koritala, chief product officer, Infogix
We’re in an evolving era of health care insurance coverage, largely driven by the dramatic increase in individuals covered by The Affordable Care Act.
It’s an evolution, however, that is not yet complete. From plan design to customer acquisition and payment to health management, everything we know today about managing the customer lifecycle today is changing, and will continue to change.
To illustrate:
| Current State | Future State | |
| Plan Design | Value-based benefits, increasing choice and transparency, and customer cost burden | Disaggregated plan design and networks; Customized benefits with diverse options |
| Customer Acquisition | Public and private exchanges; Employers, Brokers, New Players | Omni-sourced, consumer-driven more akin to retail (ie Wal-Mart/Amazon) |
| Payment | Value-based, multiple parties and structures, increasingly consumer and mobile | Fee at POS, transparency on coverage, consumer-directed, electronic |
| Health Management | Population health management, prevention & wellness | Patient empowered; Provider, Pharma, Payer and Vendor Partnership |
The shift to a more consumer-centric model will require a new customer experience strategy, and all of these changes will require better big data management.
According to The White House, 11.4 million Americans signed up for the Affordable Care Act by the end of the official enrollment period on February 15. By 2017, 24 million Americans will be enrolled in public healthcare exchanges, according to The Congressional Budget Office (2013). In addition, the trend of large companies moving to health savings accounts, defined contribution models and greater use of private exchanges creates an ever-more complex set of processes for both the consumer and the payer.
As more people transition to a future with highly customizable healthcare benefits and diverse options, insurers will need better data management practices to successfully acquire, engage and retain a cast of free-agent members who are free to choose alternate plans every enrollment period.
Accelerating the Acquisition Process
“The first customer experience is the enrollment process,” said Greg Caressi, senior vice president, healthcare & life sciences at research firm Frost & Sullivan in a recent Infogix webinar. “Best-in-class organizations are taking a systems approach to onboarding new members; as well as to managing payment and reconciliation. They’re automating and integrating the reconciliation process. They’re better managing these problems to speed the time to enrollment completion, which creates the best customer service experience for new members.”
This speed to completion is critical because a new member isn’t actually a card-carrying new member until they’ve paid their first month’s premium. Therefore, the quicker the insurers can drive them through the enrollment process, the quicker everyone, including the insurer, gets paid.
Independence Blue Cross Senior Vice President – Healthcare Reform John Janney said, “We realized very quickly that there were a number of places where failure could occur, and if a failure did, in fact, occur, where it would create a membership issue. Any point of failure that occurs along that line will, no doubt, create a problem for the member.”
While Independence Blue Cross put a number of controls in place, it realized it needed enterprise capabilities to ensure it did well by its members during what can be up to a 37-day process with more than a dozen transactional steps along the way from application completion to enrollment completion.
By monitoring the feeds from these transactions, Independence Blue Cross can flag fallout queues for missing or incorrect information, which not only helps the insurer meet its regulatory requirements with the Centers for Medicare and Medicaid Services, but also ensures that it provides a good member experience.
Shifting Focus to Engagement and Retention
Now that the second round of Affordable Care enrollments has come to a close, insurers are sure to shift their focus to other aspects of the healthcare insurance consumer lifecycle – specifically engagement and retention.
As insurers better understand their individual customer’s needs, they will be better equipped to engage with them by: helping them better understand how coverage works, providing better tracking options for their medical expenses, giving them a better variety of shopping options, sending them automated medical and screening reminders, and educating them on prevention and wellness programs, tailored to their specific healthcare profile.
“Members are going to benefit from better information,” Caressi said.
But all of these things will involve new processes, new engagement strategies and they’re going to involve new technology tools – most of which are not yet in place in the healthcare sector.
“Providing the right information to the right people at the right time is definitely a challenge that payers are going to have to face,” Caressi said.
To retain members, insurers will need to stay aligned with increasingly sophisticated health consumers to improve individual customer service while managing individual healthcare costs.
“Technology and enterprise technology will continue to be a crucial component of the insurer’s ability to support better customer relationship management, plan design, process management and operations. It will also help manage this new ecosystem of customers and partners to maintain a balance that achieves the shared goals of all ecosystem partners,” he said. “Data controls and data integrity that enable internal and external reconciliation are critical to business operations – particularly with the crush of new members and, of course, data controls are required to meet regulatory compliance.”
In closing, the mantra is Acquire. Engage. Retain. Repeat:
Acquire: Segment and target those customers with the highest propensity to choose new plans. Ensure the integrity of the data obtained from the enrollment processes through the healthcare exchanges.
Engage: Manage the membership and claims processes to ensure customer satisfaction while managing risk and financial processes.
Retain: Apply predictive analytics to propensity to churn and manage fallout.
Companies that live by this mantra will be better prepared to manage the customer lifecycle in an evolving era of healthcare insurance coverage.
Bobby Koritala, chief product officer, joined Infogix in 2009 and leads the Product Management and Development Group. Prior to this, Bobby served as the Director of Risk Technology Solutions at Protiviti, COO of Spark Biotech, Vice-President of Investments at Open Prairie Ventures, Director of Applied Technology at Blue Cross Blue Shield, Director of Product Development at Lexis Nexis, and Senior Manager, Software Development at SPSS. Bobby has a Bachelor of Arts degree in Computer Science and Physics from Coe College, a Master of Science degree in Computer Science from the University of Wisconsin, and an MBA from the Kellogg School of Management, Northwestern University.
