In the new era of individual consumer-based health insurance, insurers have to earn the trust of Americans if they want to address the costly chronic disease burden.
It's a new challenge marketing and selling to individuals, compared to the traditional group-based insurance model that's gradually declining as more employers either shift to self-funding or adopt exchanges.
Beyond that is making plans more valuable for individuals -- many of whom can easily switch to another insurer -- and engaging them on their health needs and risks.
Coming from a health plan, the province of prior authorizations, that type of engagement may or may not be welcome by individuals. But to tackle the nation's chronic disease crisis, insurers are going to have convince their members to make lifestyle changes and embrace wellness, which may require some experimentation and iterative designs in new engagement strategies.
Health insurers focusing on "the consumer is new," said consultant Kevin Riley at AHIP Institute 2014 in Seattle. Riley, who formerly worked as Florida Blue's first chief innovation officer, said such a focus has "not been done in the insurance industry before."
Ideas about accountability
As insurers develop and refine strategies for this marketplace, it's worth considering the variation in consumer segments they're trying to engage with, and the approaches needed to intervene among the most at-risk across the segments.
For one thing, "Change your language and think about variations in delayed gratification," argued Jennifer Haid, VP of consumer strategy at Iconoculture, a division of the Corporate Executive Board Company.
A cultural anthropologist, Haid has probed consumer attitudes on health insurance, health and wellbeing, illness, lifestyle and interventions. By and large, she has learned, many Americans agree that they are responsible for their health -- that they're making the decision whether or not to exercise regularly, for example -- but many do not subscribe to the idea of accountability in the financial sense.
And, Haid argues, many Americans with chronic conditions or unhealthy habits don't relate to the traditional intervention approaches that encourage changes as a mean to endpoints such as controlled blood pressure, smoking cessation and weight loss.
"Smokers don't know what it feels like to not smoke and overweight people don't know what it will be like to lose 50 pounds," she said.
Insurers -- or providers, for that matter, looking to personalize interventions -- need to give at-risk individuals a sense of what the outcomes will do for them. "Make it craveable," she said.
Digital health strategies, such as via reminders on smartphone apps, have potential here.
Instead of telling individuals to go for a walk simply to meet a certain number of steps taken in a day or calories burned, it's more effective to remind them to walk their dog or play with their children, according to Andrew Rosenthal, group manager of wellness and platform at Jawbone, the wearable, self-tracking device maker.
Rewards
Along with interventions, there's the issue of how to design and pitch rewards for members that do take the steps toward improvement -- to make sure they keep going.
While surveys by Harris Interactive have found that consumers shopping for health plans will trade access to prestigious institutions or restrictions on lab services for more affordable premium, once they're insured, premium reductions as a reward for wellness participation or behavior change can be perceived as something that should have due to to them all along, argued Riley, the former Florida Blue exec.
"Why have you been withholding my money?" is how he described the sentiment of hypothetical consumers being told they're getting a premium reduction.
Non-premium reduction rewards such as gift-cards -- something a number of insurers are offering in exchange for members completing risk assessments and preventive visits -- stand the chance of being perceived more favorably. They can LAO count towards health services spending under medical loss ratio rules, Riley noted.