Health Plans Must Reconcile Consumer Needs and Internal Change in an Evolving Marketplace

An expanding retail marketplace means that there are more opportunities for health plans to develop innovative strategies to reach consumers that are entering the market space for the first time. It is essential for health plans to not only engage these consumers but also to assist them in making good healthcare decisions. On Tuesday, Juan-Pierre Stephan, senior executive, Health CRM, Accenture, spoke about approaches and barriers to effective patient engagement.

The data-heavy presentation began with a number of statistics, including the following:

• Only 12% of employer groups say that health insurers effectively engage consumers
• 50 million new health insurance consumers are getting ready to enter the market
• Individually insured consumers make 6 times as many calls to call centers as their counterparts
• Newly insured consumers are 32% more likely to visit the emergency room than continuously insured members
• 24% of uninsured consumers go without needed care compared to 4% of insured consumers

Accenture initiated studies to determine what exactly all of these statistics could mean for the marketplace. The results provided 4 insights that are key to the success of health insurers:

1. Aligning incentives and communicating value. While retail consumers value affordability above all else, said Mr. Stephan, they are not willing to make certain tradeoffs to save costs.
2. Delivering personalization and innovation. Many of the consumers surveyed made clear their interest in insurers that are open to providing innovative models and more personalized communication. These are important factors when considering that health insurance plans will likely need to compete on more than a financial level when health insurance exchanges take place.
3. Becoming digitally relevant. Although consumers still demand live customer service, they have become extremely digitally savvy. Health insurers must do the same.
4. Building trust to advise. “Consumers want help and guidance to improve health, despite not taking the advice they are being given,” Mr. Stephan said. A lack of trust is evident based on statistics that show consumers are leery of the resources and tools insurers provide compared to what their health provider gives them.

Part of the problem insurers now face in this evolving landscape is the fact that consumers often define themselves into segments differently than their insurers do. Many insurers use antiquated techniques to segment their populations, and this needs to change in order to succeed in a much different and constantly changing landscape. Unfortunately, Mr. Stephan said, change needs to come from the top. Barriers like fragmented project implementations and a lack of enterprise sponsorship can deter organizations from enacting change that could lead to success in a new marketplace. Additionally, said Mr. Stephan, the influence of employee engagement as a catalyst for change is vastly undervalued at many organizations. However, it is not too late to enact company-wide transformations. If organizations are able to break down the silos, identify core competencies, and align incentives (both internally and externally), they stand to enjoy early and continued success in a highly competitive market.