The proliferation of high-deductible plans (HDHP) has created rising resentment in members who believe that insurers charge high premiums for health plans with poor benefits. Unfortunately, there's some truth to that argument as members often face significant out-of-pocket expenses with little health plan interaction until they've met their deductible–a goal no member wants to attain. While that may seem to be a prudent strategy given that over three fourths of those with HDHPs will not meet their deductible, it’s short-sighted. The premium contribution of these members is not only vital for sustaining the viability of the plan’s risk pool, the members also represent the voice of the rest your customers. Why not take the opportunity to provide services and assistance to members before they reach their deductibles?
While the phrase, positive customer experience, is much touted, health plans have an almost universal reputation for poor customer experience and are often at the bottom of lists rating industries for positive customer experience–despite the numerous seminars, consultant expertise and changes in job titles implemented by health plans. Sadly, given that members have low expectations of their health plans, it won't take much to improve their experience.
Here are eight ways to start …and to go a step further:
Get the basics right. At least two weeks before a new member’s effective date, send an ID card, access to an up-to-date on-line provider directory, benefit details and plan contact information should be, bot often aren’t, no-brainers.
You can go a step further: Throughout the year, use the full range of communication media to provide regular touch points to your members about how to maximize benefits and services and provide supporting tools and apps for their use.
Answer member and provider calls as quickly as possible. Hire and train enough customer service staff so some can make outbound calls when they're not busy with incoming ones. Your team will be able to make follow-up calls to determine whether issues have been resolved and to enforce a culture of customer satisfaction.
You can go a step further: Get rid of your IVR and answer the phones with real people. Also, when members receive their enrollment materials text each of them to ask if they would like to have a customer service rep walk them through their benefits and how to make the most of them. If the answer is yes, then schedule an appointment for a call or even a video chat. Make it easy for your members to get their questions answered. If you want to be radical, rotate your management team through the call center to listen to incoming calls, 30 minutes per month for each would be eye-opening and provide numerous opportunities to improve true customer experiences.
Spend extra effort helping members understand prescription drug benefits. Most health plans have a preferred drug list with tiered co-pays. While it makes sense to health plan staff, it often doesn't to members. Since more members, by far, use their pharmacy benefit than any other aspect of their health plan, it is an important one to get right. Make sure that you clearly explain the pharmacy benefit and options and test that explanation on a focus group. Explain specialty drugs, drug adherence and the importance of managing drug interactions and complications.
You can go a step further: Add appropriate over-the-counter medications to covered benefits so that their use can count toward a deductible. Offer support programs to members taking multiple medications or with co-morbidities. Identify members taking anti-depression or anti-psychotic medications and reach out to them about additional services that may be of help.
Help manage the deductible. One of the best way for members to maximize their deductible is to stay in-network. For that to work, an up-to-date on-line provider directory tool with information about each provider and their availability for new patients is essential. Inaccurate directories are all too common. Also, while a number of health plans are beginning to offer price transparency tools, most don't offer enough information to be useful. Plans should provide tools that include specific information related to geography, offer useful provider comparisons that have accurate and up-to-date information.
You can go a step further: Beyond offering a directory and allowing a member to sign up with a primary care provider, have them to complete or update their medical history and schedule their first appointment from your website. In addition to a price transparency tool, provide alternatives for members to consider when faced with elective surgery, physical therapy and other treatments. Add an option for medical tourism for members interested in traveling outside the US for high quality treatment at a much lower cost. Include a telemedicine program in your network for after hours or minor emergency care and explain the costs of telemedicine vs. urgent care vs. emergency departments. Make staff available to talk with members about how to maximize their benefits and how to choose or utilize their provider effectively. Use this option to demonstrate the value of your plan.
Give your members a chance to critique your health plan. Beyond administering the annual CAHPS survey, understand what your members like, dislike and want to see changed about their benefits. Would they recommend your plan to a friend?
You can go a step further: Host member advisory groups and bring your members in to better understand what they want from your plan. Send periodic surveys to members to see how you're doing–not just the standardized ones. Don’t forget to include providers services in your surveys because those experiences can color members perceptions of your plan. When the plan does something wrong, give the member something for their trouble e.g., movie tickets, gift cards, etc.
Help your members stay healthy. Incorporate a healthy practices page on your website that offers regularly updated information for members. Encourage feedback and links to useful sites.
You can go a step further: Offer access to discounts on a wide range of health-related products from bicycle helmets to exercise equipment to healthy foods. Contract with Amazon, national retailers or locally-owned businesses to offer discounts and access to health-related goods and services. Give members the opportunity to contact nutritionists, psychologists, pharmacists and providers with questions. Be the go to place for helping people manage their own health.
Thank your members for their business. Too often the only communication that a member receives after paying their premium month after month is an impersonal annual renewal notice with a rate increase. Planning for a member's renewal should begin upon enrollment. At the time you enter the renewal period, send a warm thank you communication (email or letter) to them and ask them for their business again.
You can go a step further: Call members and encourage them to re-enroll. Make sure your staff is prepared to respond to questions or issues that either have not been resolved or have never surfaced before–allowing your representative to explain why the member should remain with your plan, including information related to rates. This is the time to demonstrate the value your plan brings to its members.
Develop the total buy-in and commitment of your employees to member satisfaction and retention. A regularly updated, robust training program should be a requirement for everyone in the organization. In addition, align your employee incentive program for all employees with each of your efforts and report on their progress frequently.
You can go a step further: Keep the ball rolling. Continue to perfect each effort and be innovative about new ways of providing top notch service. Engage employees in regular brainstorming sessions. It’s your front-line team members who can often provide the best insight into member concerns and opportunities.
If you've dismissed these ideas because they would cost too much or are too difficult, remember that most of those selecting high deductible plans will have no claims cost above that deductible. So put yourself in their shoes, when given a choice, why should they select your health plan?