Secure membership in changing times

MANAGED CARE’S COMPETITIVE landscape has become rough terrain with no clear paths to follow. With enrollment falling and potentially detrimental health reforms hanging overhead, plans are looking to realize gains in emerging markets and retain current members through improved service.

“Service is an important competitive battlefield in the health-service business,” says Joseph Mondy, CIGNA company spokesperson.

CIGNA recently extended the hours of its service call center to 24 hours, seven days a week, to answer questions about claims, benefits and eligibility and to assist in locating network providers. Mondy says CIGNA is the first health plan to offer this service 24/7 to members and providers.

“We see the competitive field broadening,” he says. “Other non-traditional players are getting into health services, and we have to be able to compete with them, not just our traditional competitors.”

By rebalancing the workloads of the call center staff, CIGNA was able to extend the hours without incurring additional administrative costs, Mondy says. Select representatives are also proactively reading Twitter tweets to reach out to members who might benefit from their assistance through social media contact.

Job losses caused by the recession and the cost of insurance coverage are the two main factors causing health plans to lose enrollees. Large national insurers are reporting overall membership losses of 5% or more. Humana, for example, saw its fully funded group lives fall nearly 8% in the second quarter of 2009.

TAPPING INDIVIDUAL POTENTIAL

However, many speculate that the individual market has potential now, particularly with Congress still in the process of hashing out legislation to increase coverage in the near future and employer-sponsored coverage on a downward trend.

For Humana, membership grew 17% in the second quarter in HumanaOne, the company’s individual business unit. It began writing single policies in 2002 and now has 350,000 enrollees.

“We built the business unit from scratch in a three- to four-year period,” says Doug Bennett, Humana director of corporate communications.

Bennett recommends that plans maximize their Internet presence to connect with individuals seeking coverage. For example, he says, writing online content in plain language can make a site more search-engine-friendly.

Tami Quiram, HumanaOne director, says the individual market has been somewhat untapped because employees losing their group coverage tend to consider COBRA as their only alternative. Direct marketing and live call center assistance is the best way to reach that segment, she says.

“It’s really a retail business with people making independent decisions,” she says. “There’s nothing more consumer-centric than an individual making decisions about the tradeoff between premium and benefit.”

According to David G. Knott, senior vice president and global practice leader, Booz & Company, insurance exchanges—heavily advocated by health reform thought leaders—will offer plans opportunity in the individual and small-group market.

“That’s going to be an important change because it forms exchanges around purchasers who did not have much negotiating clout when they were buying benefits in the past,” he says.

Plans will need to improve their marketing, segmenting and selling in the individual market, even though most plans have largely focused on business-to-business relationships in the past. Building a brand with marketable products and offering post-enrollment service to individual buyers who don’t have a human-resources advocate will help differentiate plans in an exchange. Competitive exchanges could also drive prices down, however.

“For plans already serving those markets and relying on those segments for some of their profit margin, they also need to think through how they keep their profit picture in tact,” Knott says.

In addition to targeting the individual market for future enrollment growth, plans also have an opportunity to address underserved racial or ethnic segments. These groups are less likely to have health coverage and less likely to have a regular healthcare provider.

Regence BlueCross BlueShield in Seattle recently won a national award for its Conserjero program to help Spanish-speaking members navigate the healthcare system. It is the initial segment Regence has identified as an emerging market with growth potential. And it’s no wonder, considering Latinos are expected to comprise 30% of the U.S. population by 2050.

“For Latinos, it’s about family and community,” says Francisco Garbayo, assistant director of emerging markets. “We are great consumers, and we buy things for different reasons than the general population might. If you understand the culture cues of that market, you can build a campaign that addresses those cues.”

The Regence campaign reaches the Latino market through community avenues and involves the family instead of the typical individualistic marketing strategy, Garbayo says. For example, health fairs and community events offer opportunities to provide education about how the U.S. healthcare system works and to promote the company’s toll-free number for Spanish-speaking consumers.

According to Garbayo, the program has helped influence new business. In fact, employers with significant Latino populations have increased that group’s health plan enrollment to as much as 95% with the help of Conserjeroeducation tools.

“It’s a pretty healthy, young population,” he says. “One of the things you look for when you market is return on investment, and that comes in many forms. Brand loyalty, for example, is a huge advantage in marketing to a Latino population.”

IDENTIFY HEALTH DISPARITIES

Rhonda Moore Johnson, MD, medical director for Highmark Inc., anticipates more diversity in employer groups in the coming decades and believes member-centric service needs to address health disparities. There is an opportunity to identify and correct disparities, which begins with collecting racial and ethnic data from members, she says.

A policy brief from Mathematica Policy Research published last month found that employers lack awareness of healthcare disparities and are uncertain of the legal implications of sharing race data. Highmark asks for race data directly, but emphasizes that the information is optional and is only used for quality improvement.

“The business case is that all this information [about health disparities] is available,” Dr. Johnson says. “We know the trends in this country in terms of higher rates of chronic disease. We know the rates of care for minorities lag behind non-minorities for some chronic conditions.”

In 2009, Highmark saw an increase of 27% in Hispanic/Latino commercial PPO members who underwent colorectal cancer screening after receiving personalized education about the importance of colorectal cancer screening. According to Dr. Johnson, improvements in prevention like this wouldn’t be possible without the collection of the members’ data and the match up against clinical performance.

If you enjoyed this post, make sure you subscribe to my RSS feed!