Growth strategies of the main payers


A strong strategy based on innovation and customer service is winning the day, as payers try to make sure not only to keep the customers they have, but to attract new ones in order to be successful.

Make connections

Tom Wicka, CEO and Co-Founder of NovuHealth, which serves more than 40 healthcare plans in the United States, says that regardless of product segment, the success of any payer depends largely on their ability to engage consumers. .

“Few payers have mastered consumer engagement – historically they haven’t had to,” he says. “But with the growth of consumerism in healthcare and the shift to value-based care, making meaningful connections with consumers has become imperative.”

Therefore, to remain competitive, he says, health plans need to take inspiration from major consumer brands and embrace the best consumer engagement practices they have already perfected, including user segmentation and consumer engagement. propensity analysis, personalized content and communication channels, and rewards that not only inspire action but build long-term trust with members.

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Christine Paige, director of marketing for Kaiser Permanente, an integrated care management consortium based in Oakland, Calif., Says one of the most significant changes over the years is the move towards greater personalization.

“There has been an increased use of what people have told us about their interests and preferences to make information and dialogue more relevant,” she says. “It is different from the one-time communication that prevailed before.”

Choose a focus

Nick Brecker, president of specialty operations at Anthem Blue Cross Blue Shield, an Indianapolis-based health insurance company, said the company’s strategy is focused on delivering cutting-edge products combined with a cutting-edge approach. “comprehensive health care for the person”.

“While our specialty products (dental, vision, life and disability, and voluntary supplemental health plans) are available on a stand-alone basis, they can be combined with our health plan products to better coordinate care, which translates into more efficiency, better health outcomes and greater savings, ”he said. “This is made possible by Anthem Whole Health Connection. This unique approach to holistic human health connects claims and clinical data to identify and influence gaps in care, reduce costs, and provide a simpler healthcare experience for our consumers.

He notes that healthcare is inherently personal and that Anthem Blue Cross Blue Shield’s (Anthem) specialty business aims to help make healthcare delivery as personalized and relevant as possible for each consumer.

“Our integrated approach to ‘comprehensive health care for the whole person’ means we have the opportunity to help our consumers better manage their health problems through early intervention and by filling gaps in their care,” says. he.

John Nicolaou, a healthcare payers expert at PA Consulting, explains that payers need to acquire customers from their competitors in order to grow organically.

“The emphasis is on differentiating brands and services rather than differentiating products or benefits,” he says. “An example would be tools to help predict out-of-pocket payments, or to encourage and reward healthy lifestyle behaviors to help members manage their healthcare costs. “

There are also similar ways for employers to better manage the cost of care, including better analysis of claims or rewarding healthier behaviors.

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“It will be essential to make these brand and service differentiations attractive, relevant and valuable to members, rather than gimmicks for payers,” said Nicolaou. “The key to this is to understand not only who their members are, but rather to understand their relationships with payers and the health system as a whole to find ways to differentiate themselves. “

Chris Seib, CTO and co-founder of InstaMed, a healthcare payment network in Walnut Creek, Calif., Says payers need to focus on improving the member experience and examining the experience of members. consumers in other industries to understand the references.

“According to the ninth annual Healthcare Payment Trends Report, 86% of consumers want all of their healthcare payments to be made in one place,” he says. “Payers can help consumers meet this need by offering payment capabilities within their member portals. Payers can eliminate healthcare payment frictions and increase member satisfaction, increase member portal traffic and tool usage, and accelerate member payments to providers.

Lissy Hu, CEO of Boston-based CarePort Health, says payers are leveraging the CarePort care coordination platform to achieve quality and financial results.

She explains that specific opportunities for payers to leverage CarePort include: guiding members to the most appropriate level of care, enabling emergency department diversions, tracking patients in real time to support effective care transitions, and increase the success of the first submission around post-acute authorizations.

“CarePort’s broad provider footprint enables payers to have optimal visibility into member utilization and progression across care settings, which helps improve quality and costs and patient experiences,” Hu said. “Almost 1,000 hospitals and over 20,000 post-acute care providers use our platform for comprehensive care transition workflows, including utilization management, discharge planning, discharge coordination. care, results monitoring and refinement of workflows. “

Direct to employer program

Stewart Schaffer, co-founder and managing partner of CSuite Solutions, a healthcare consulting firm based in Tampa, Florida, notes that employers are keen to work directly with healthcare systems to provide healthcare coverage for their employees. and that health systems also wish to work directly with employers to do the same.

“Both parties are already aware of the many potential benefits of working face to face, so the market is paramount for employer-direct group health plans,” he says. “All that’s missing is the infrastructure, the technology and the expertise to make it all happen. Our sales and marketing strategy is simply to tell the story of how the combined expertise and experience of CSuite Solutions and KBA came together to make it all happen.

With this in mind, when looking to add clients, CSuite Solutions focuses on risk management, plan design, complaints handling, open enrollments, case management, care coordination, proactive management. health and overall customer service.

“You have to take a business approach to delivering these programs. This is not just a network procurement exercise. By that I mean that health systems have to see these programs as if they are embarking on a new activity that is quite different from what they are doing now, ”Schaffer explains. “The mere thought that having employers as clients is a whole new world for them needs to be accepted across the organization. We understand and facilitate the cultural acceptance of these programs throughout the company so that positive results can be ensured. “

Keith Loria is an award winning journalist who has written for major newspapers and magazines for almost 20 years.


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