Health plans are evolving into customer-oriented organizations as a result of the Affordable Care Act and requirements for transparency and more value. One way insurers can help their customers is to tie together their front- and back-end systems to focus on the consumer's needs and experience, according to Dell Services.
The company will present a session on "After Exchange Launch--What Should You Be Doing to Prepare for 2015?" at the Operations and Technology Forum 2013, sponsored by America's Health Insurance Plans (AHIP) in Chicago Nov. 18-20.
A number of forces are driving the rise of consumerism in the health plan industry--not just the ACA, but the general expectations consumers have, said Andy Arends, managing principal for health plan innovation and consulting at Dell Services, and who will lead the session Wed., Nov. 20.
Consumers generally see the primary function of health plans as paying a provider claim, but that is a transaction that is becoming more standardized.
"Health plans are seeing auto adjudication rates of more than 90 percent, so that no longer needs to be the focus of their business," he said. "The focus needs to be how to keep their customers and providers engaged."
Previously, health plans have taken a fragmented approach to customers. For example, most health plans rely on their core administration system to be their customer relationship management (CRM) platform, which doesn't give insurers the necessary tools.
"We want to bring that together so that there is almost a no-wrong door approach for consumers coming in to exchange plans," he said.
Arends will describe a framework for embracing consumers via traditional, digital, and physical/retail methods and what is needed in analytics, applications, security, and infrastructure to accomplish that.
Businesses are moving away from stand-alone systems towards CRM programs that are cloud-based, which enables health plans to more efficiently deploy tools. Over time, they can add more cloud-based infrastructure, Arends said.
Churn in eligibility between Medicaid, subsidized exchange products and then non-subsidized exchange products is challenging. "The relationships that health plans establish with their customers will have to be able to transition to cross those," he said.
Health plans need to take a cue from service businesses. When consumers want to terminate their cable or cell phone plan, the company has strategies, business divisions and tools to try and retain the customer. Health plans are going to have to create those types of organizational units and tools.
For example, if someone is losing their Medicaid coverage because they haven't done their paperwork, what kind of assistance can the health plan provide in helping maintain that Medicaid eligibility? Or if they're moving from one subsidy category to another, what can the health plan do to help them in that process?
"We've got to do a better job of helping the consumer through that process. We should be able to drive some customer loyalty," Arends said. He plans to provide some case studies of plans that have engaged their customers in innovative ways.