Under the Affordable Care Act, health plans have been striving for a business model that shifts away from an employer-centered approach to one that puts consumers at the center of their organization. At this point in time, the health care marketplace still lags behind other industries in this transition. While there isn’t a singular approach or process to becoming consumer-centric, organizations can take certain steps to create effective front-office structures that will grow and retain membership, manage costs and improve the member experience.
1. Prioritize consumer engagement. Placing more emphasis on consumer engagement can assist with other front-office goals of channel optimization and business process transformation. This will allow plans to:
- Develop and execute against a consumer strategy.
- Provide personalized tools and services that drive positive behavior decisions and lead to cost-effective decisions.
- Evolve business-to-business infrastructure to support emerging market demands.
2. Make room for “big data.” Legacy systems and disparate data make it impossible to deliver real-time consumer experiences. The enhanced data that is available beyond claims can help organizations improve both their prediction of health care spending and service utilization. With high-volume, high-velocity and high-variety information, plans can effectively implement the four key elements of consumer-centric solutions: personalization, seamlessness, simplification and transparency.
3. Optimize staffing. Shifting the focus to consumers can impose unique staffing demands given that seasonal demands place more emphasis on operational scalability. Plans willing to invest the time into quality representatives and train them on supporting multiple business segments can significantly reduce staffing requirements, sometimes as much as 40 percent. This can become relevant during the slow season.
4. Go through the right channels. Plans cannot be successful in front-office transformation if they are not using the consumer’s “channel of choice” — web, email, phone, text, click-to-call or click-to-chat — to reach out and communicate with members. Consumers are more likely to buy and leverage medical management programs if their plan is communicating with them through the channels they prefer. Plans that do not have the capability to engage multiple channels should consider outsourcing or upgrading their communications platform.
For expanded content on front-office transformation, please download our article, “Consumer-centric front office uses data and outreach to engage members.”
Clay Heinz, Vice President, Business Development, Optum
Heinz is responsible for developing new business concepts at Optum. As Vice President of Client Practice, he lends his expertise and innovation to payers, providers, employers and government entities in the health care marketplace. Prior to joining Optum, he worked for Extend Health as an innovator in the early years of exchange-based sales.
Herschel Reich, FSA, Vice President, Actuarial Consulting, Optum
Reich is Vice President, Actuarial Consulting for Optum Payer Consulting. In this role, he manages the Optum New York Office. Reich is currently leading the Optum Actuarial Toolbox and Specialty Benefits consulting practice. He has over 25 years of experience with health plans in actuarial, management and strategy roles, the last 10 with Optum.
Lori A. Stevens, FSA, Senior Vice President, Payer Solutions, Optum
Stevens is Vice President and General Manager for Optum Payer Acquisition and Retention solutions. In this role, She is responsible for the strategy and business development of payer sales solutions supporting modernization, efficiency and growth goals. Stevens joined Optum in 2000 and has over 20 years of experience with health plans in actuarial, management and strategy roles.