Member Engagement: What's at Stake

The health insurance landscape is quickly changing and could be upended again. At the center is the consumer. Here's why customer engagement remains a priority for healthcare companies.
Customer Experience

Last week was a critical moment for consumers and the healthcare industry as the Supreme Court deliberated on the fate of the Patient Protection and Affordable Care Act in the King vs. Burwell lawsuit. Roughly 6.4 million people could have found themselves without health insurance if they had lost certain tax-credit subsidies for insurance coverage offered under the Affordable Care Act.

For payers, the ruling could have greatly impacted companies that mainly offer individual and family health plans. And while these fears didn't come to pass, insurance companies continue to compete for members. In fact, customer engagement is a priority for healthcare companies as they strive to meet rising customer demands from employer groups and individuals, say industry experts and analysts.

The Value of Storytelling
Taking a storytelling approach to engagement and education can help payers better meet members' individual needs, maintains Michael Sturmer, senior director of consumer health engagement at Cigna. Such an approach demonstrates that insurers understand a member's particular needs and can tailor their content appropriately. "We need to get better at telling our story and engaging individuals," Sturmer says. "For instance, medication compliance might not be top of mind for a consumer but if we can present reasons why it's important in a way that's relevant, we can help that person be healthier."

Earlier this year, Cigna launched a web-based application called Cigna Compass that uses a member's medical plan history, biometric data, claims history, and other data points to create personalized alerts about opportunities for members to improve their health and lower their healthcare costs. The features include information on how to lower your out-of-pocket costs, reminders about ongoing reward programs, and benchmark comparisons with peer groups.

Users receive these alerts through email and when they log into the program. Cigna launched the pilot program with JP Morgan Chase in January and early results show that 72 percent of users would recommend Compass to a colleague and 62 percent said that Compass helps them make better decisions regarding their health. Cigna is also extending Compass to 19 other employers, Sturmer says.

Compass as well as other initiatives like Coach by Cigna, a personalized health coaching app, are part of the company's efforts to customize its services and content according to a holistic view of a member's health needs.

Susan Mende, senior program officer at Robert Wood Johnson Foundation, agrees that leveraging contextual information about a patient or member is critical for providing the best care. "Providers and insurers must take a comprehensive look at the person," Mende says. "What are the social factors that are involved? Is this person not following the prescribed health plan because they don't have time or can't afford to do it?"

While there are no easy answers to overcoming these obstacles, peer-led programs are showing promise in helping patients control chronic health issues like diabetes, obesity, and arthritis more effectively than if they were by themselves, Mende adds. "People learn best from those they can relate to and programs like Pathways to Health, which we helped sponsor, train people to help others who have similar difficulties," she says.

Say No to Jargon
Consumers increasingly expect businesses to provide them with engaging and user-friendly experiences, which healthcare organizations struggle to provide. Indeed, even college students and recent graduates find it difficult to sign up for insurance, according to a recent studypublished in theJournal of Adolescent Health.

Researchers at the University of Pennsylvania observed 30 adults ages 19 through 30 as they navigated through to sign up for insurance coverage. Many of the participants, however, lacked a basic understanding of insurance terminology and expenses. Half of the participants could not define "deductible," and three out of four couldn't define "coinsurance." Additionally, a majority were unaware of insurance subsidies, and didn't know how much insurance plans generally cost.

While the study involved a small sample group, the results are similar to other studies that show insurance companies and the government needs to do a better job of educating people about healthcare basics, Sturmer says. "Presenting someone with a 300-page benefit package isn't going to work" he notes. "There are still more opportunities for the healthcare industry as a whole to better engage consumers and jargon and complicated explanations are just some of the many pain points that have yet to be removed."

Payers and providers should also consider a consumer's preferences for how often they receive information and the context in which it's delivered, adds Ingrid Lindberg, founder of the consulting firm Chief Customer and former chief customer experience officer at Cigna. "Companies have to pay attention to the broader context of how they're engaging consumers," Lindberg notes. "You may not want to receive a push notification reminding you to take your medication during a meeting, but I've worked with clients who didn't even consider that." Allowing members to customize the frequency and format of the information they receive and using A/B testing to find the most effective approach can deliver a much better experience, Lindberg adds.

Building Trust
Gaining the trust of your customers is critical. Members who say they "strongly agree" that their health plans are trusted advisors are less likely to switch health plan providers, according to a J.D. Power study that surveyed members of 134 health plans last year. "Payers must appeal to the consumer's trust instincts and transparency is a big factor," says Stan Nowak, CEO and co-founder of Silverlink Communications, a healthcare communications platform provider.

In addition to offering cost calculators and other tools to help consumers make informed decisions, member experiences are not isolated, and word-of-mouth recommendations and reviews on third-party sites like ZocDoc and Consumer Reports are also important. Payers must stay on top of what consumers are saying about their services and respond quickly, notes J.P. Stephan, managing director for the AccentureHealth Customer Relationship Management (CRM) group. However, insurers are still a long way off from building the lifetime value of a member at a scalable approach, he adds.

"Lifetime value is a concept that's still on the horizon for many healthcare organizations," Stephan notes. "LTV assumes you can sell a core product and extend that relationship with a consumer but what we've found is consumers still have a perceived bias against insurers and so the reality is insurers still have a way to go."

Additionally, payers need to get better at engaging consumers on a personalized level, observes Pat McCaffrey, senior vice president of healthcare and the public sector at TeleTech. "Health plans have to get more sophisticated at one-to-one engagement," McCaffrey says. "They have to know who their potential member population is and the connection between someone searching a website and the likelihood this person will convert, and do much better targeted marketing."

Even before the Affordable Care Act's coverage mandate pushed consumers to examine their health insurance choices, they have been taking an increasingly active role in their care experience. Healthcare companies noticed and are striving to provide more consumer-friendly experiences, albeit at a slower pace compared to other industries. And while price continues to be an important factor, members are also more likely to remain with a company that provides them with accessible information and valuable member experiences.

Indeed, "there's still a very strong value proposition for payers to continue to embrace customer engagement," Stephan says. "Employer groups as well as individuals are demanding more options and better user experiences and there are no signs of that changing."