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Our recent consumer survey showed that 47% of the 3,000 respondents postponed care. And of that 47%, 55% delayed routine visits, 39% elective treatment, 32% essential treatment of a chronic condition and 22% emergency care. This might be slightly elevated because of the fear factor related to COVID-19, but many people may not be aware that consumers postpone care all the time. Many times, it’s because of the desire to avoid high costs.

So, it’s no surprise that when asked what services would improve the consumers’ current level of satisfaction with their health plan, tools or information to help understand benefits and financial responsibility (55%) and to help find less costly care (49%) topped the list.  Confusion continues beyond just transactions and expenses; the consumer survey also found that 50% of insured American adults don’t know all the services covered under their health plan.

Value-Based Reimbursement Collaboration is Essential for Keeping Members Healthy and Lowering costs

Confusion around health insurance costs and coverage leading to delayed care is critical for payers to address because healthcare is changing, and the focus is shifting to quality. As the industry moves to value-based reimbursements, members avoiding care can actually drive costs up. Many regulations are requiring evidence of quality in the hospitals, health plans and clinics, etc. As a result, providers can be rewarded financially for demonstrating quality and keeping patients healthy. The benefit to payors is, if members are kept healthy, costs for everyone can decrease, and member satisfaction can increase.

For a high-risk Medicare member, a health plan might receive several thousand monthly reimbursements from CMS to care for that member. If the member gets sick, the cost of care chips away at that reimbursement. If the health plan and the provider work together and keep that member healthy, everyone benefits, including from a financial perspective. Preventative care and proactive treatment to keep members healthy benefits everyone in the healthcare ecosystem.

The Communication Gap in Preventive Care

Despite the benefits of Value-Based Reimbursement Collaboration, there is still a communication gap when it comes to supporting and promoting preventive care.

According to the consumer survey, when asked if a health insurance company, primary care physician, or a specialist directed the consumer to a community resource like Meals on Wheels or housing assistance to further support their care, 72% said no, including 83% of Medicare Advantage members and 77% of Medicare members.

“There is a significant communication gap and missed opportunity for the most vulnerable populations to take advantage of the resources available to help improve their care and overall well-being. There is also evidence that consumers will use these resources if they know they exist. For those directed to community resources, 81% engaged with the services—up from 57% in 2019.”

Consumers want tools to understand their costs, benefits covered, community resources, and overall better communication; if payers and providers work together to improve outreach and overall transparency, it will keep members healthy, lower costs, and benefit everyone in the long run.

EHRs, mobile devices, wearables, claims data, and population health analytics can provide enough healthcare insight to improve outcomes at lower costs. But as the use of technology and data increases within healthcare, the challenge of effectively using that data also grows. The problem is that data exists in silos.

Recognizing this, payers are increasing their investment in innovation. According to our recent survey of 222 health plan executives, 50% said they plan to make significant investments in innovation to achieve their organizational goals this year—up from 19% in 2018. While there is a consistent pipeline of disruptive applications in the marketplace, few effectively connect the key constituencies, which the industry needs more than ever.

The McKinsey Global Institute estimates that the volume of healthcare data and the industry’s inability to take advantage of it, for whatever reason (HIPAA, old technology, business strategy, etc.), leads to potentially more than $300 billion annually in wasted value.

The first step to solving this challenge is better collaboration amongst payers and provider organizations. For payers and providers to align on shared goals, they must share critical data. Both administrative and clinical data can contribute to providers taking important proactive steps to get or keep their patients healthy.

Whether directly or indirectly impacted by the Interoperability and Patient Access Rule, new market demands to equip stakeholders with information that enables them to understand and orchestrate their health care needs and opportunities will challenge the entire health ecosystem. Payers will require administrative capabilities that can deliver exceptional data integrity, data insights, and data access – to their members and the stakeholders who contribute to their care.

Furthermore, health plans that make accurate data directly available in real-time to their members and physicians within their networks benefit from greater efficiency. Customer service representatives spend more time efficiently resolving individual queries or speaking with more members on a daily basis, for example.

For members, it means they walk away from a shorter conversation with the right information or go in armed with the correct data to have a productive call – no frustrated call-backs necessary. The downstream impact of this? Increased member satisfaction—a top goal for health plan leaders— and greater likelihood of follow-through on care plans or better medication adherence to stay healthy.

Healthcare has a formidable challenge that persists: break down the silos between all key stakeholders. Only with technology that provides accurate data in real-time in a consumable manner by all will this occur. Of course, the players in the healthcare ecosystem have to want to collaborate and make the best use of these insights. Once that happens, better outcomes and an improved patient experience are inevitable.

While it may not have been a completely shocking revelation, I was excited to see one of the results of our recent survey of 3,000 consumers indicating that Medicare Advantage (MA) plans have highly satisfied members, with 55% of respondents with MA plans giving their insurance providers five stars.

MA has been an explosive area of growth for many of the health plans that we collaborate with. In many cases, it’s been a whole new line of business for organizations, or even the basis for some new health plans startups; for others, it’s been the expansion of their existing MA business in membership numbers or geography, or both. Not only is there still a large portion of the baby boomer population aging into Medicare, but increasing familiarity with and understanding of MA offerings opens the opportunity for conversion of existing members from traditional Medicare and Medicare Supplement to MA plans, including some of the older Medicare population.

With this growth opportunity comes a highly competitive health insurance marketplace, making a positive member experience critical to retaining members and growing the business. And health plans have delivered. Again, it’s not overly surprising that MA received such satisfactory scores; it’s a very high-touch, highly regulated business, down to the communications that need to be delivered appropriately and timely to that high-utilizing population, who rely on and appreciate the visibility.

On the flip side, health plans individually purchased on a public exchange received the lowest satisfaction scores from the consumer respondents, with almost 25% of respondents giving their plan a 2-star or 1-star rating. Furthermore, more than half (52%) of these members plan to scan the market during open enrollment. These statistics, along with the documented recent growth in the ACA coverage as more Americans have signed up on the federal exchange since its reopening, signify an opportunity to increase satisfaction in order to gain and retain ACA members. As health plans analyze these findings, they may consider investing or reinvesting and improving their ACA offerings.

Given the disparity in satisfaction levels between Medicare Advantage and ACA members, health plans with both lines of business have a significant opportunity to take advantage of lessons learned. They can look at both the regulated activities and best practices that have evolved in their Medicare Advantage business to see what could be applied to individual ACA plans to improve the member experience― bearing in mind, of course, the variances in funding and other regulatory activities in these distinct markets.

Additional results of the consumer survey clearly indicate that members across product lines want to fully understand their benefits and to be equipped with self-service tools that allow them to navigate and utilize their plans effectively – ultimately, to successfully manage their health.

Based on these findings, health plans may want to consider evaluating the effectiveness of existing communications and opportunities for enrichment, as well as assessing the underlying technologies and customer-facing tools in place to meet their populations’ needs.

Existing fee-for-service payment models are not scalable. Across the industry, there is an increasing emphasis on finding ways to deliver quality care while controlling costs. Health plans are transitioning from those older arrangements to new types of value-based reimbursement. There is a wide variety of effective value-based arrangements; this shift requires health plans to have the flexibility to negotiate, test, and implement a variety of payment models with more science and data behind them.

Especially on the national level, we’re seeing a conversion to using Medicare as a benchmark to make more informed decisions because it has one of the most robust data sets. For example, a health plan may use that as a reference point and decide to pay a specific percentage of Medicare, and then create some additional benefits for maternity care, different types of rehab, or cover more dental services or vaccines, among other things.

National payers need access to real-time data to find the best way to structure agreements that support their goal of providing quality care while keeping costs low. They require technology with the business intelligence tools to model and forecast different pricing scenarios, customizations, and edits to see the best way to transition from fee-for-service to value-based care reimbursement.

When taking a value-based approach, it’s crucial for health plans to have all of the information up-front and understand the impact of specific determinations on their providers. The ability to model arrangements using existing claims and run reports before putting them into place allows health plans to make informed business decisions and have better conversations and negotiations with their provider network.

The shift to new reimbursement models does not have to be contentious and can benefit all stakeholders. We’ve worked with several clients to transition to new arrangements where they can realize the cost savings while also still doing right by their providers.

People can work remotely from nearly anywhere in the world today, creating a broad market for internships and giving businesses a large, diverse pool of young bright minds to hire. With more options comes increased competition. In today’s market, how can internship candidates make an impression?

1. Good Communication

For an intern, one of the most important abilities to display to a potential employer is good communication. This may seem difficult when applying to a remote position, but luckily there are many ways to communicate that do not require being in the same room. Business forward social media such as LinkedIn allow people to connect and keep up with company news and updates. Before you even get to your interview, you can utilize LinkedIn by following the HealthEdge page and connecting with employees at the company.

2. Enthusiasm

Many people believe the most critical quality for a candidate is experience. For an intern, that is not the E word employers are necessarily looking for. “We don’t expect anyone to have a lot of experience coming in; we’re not looking necessarily for prior internships,” says Kelly Finn, Manager of Talent Attraction at HealthEdge.

The best trait you can put forward in your interviews is enthusiasm. “The things that we specifically look for are: are they inquisitive? Do they want to learn? Do they have good questions?” Finn says.

According to HealthEdge Vice President of Talent Attraction, Katie Conti, the best traits you can display in your interview are curiosity, motivation and friendliness. “I’ll tell my team, half-jokingly, ‘Don’t bring any jerks in.’ Bring in nice people who are interested in being here, who are going to be enthusiastic and eager to learn,” she says.

3. Research

The next step is proving you’ve done your research. An informed, engaged, and confident applicant stands out among the rest when all other aspects of a candidate are evenly matched.

When asked where to begin the research process, Finn suggested starting with the website, “just poke around the different pages so you can get a sense for what the company does.”

“We don’t expect you to be able to sell the company…but we do expect that you’ve looked at the website and understand generally what we do,” says Conti. Interviews are not meant to be a quiz but knowing this information can only help you come across as more confident and serious about the potential role.

Knowing enough that you can engage in the conversation, rather than just asking questions from a prepared list, is also one way to stand out because it proves you’re curious and informed. Let your questions come from the conversation and your interviewer will be impressed. You want to make sure they can tell you don’t want a job; you want their job.

For HealthEdge, ensuring your values align with the company’s is incredibly important. Excellence, collaboration, continuous improvement, innovation, and diversity are part of the core principles at HealthEdge, and if those are things you see yourself feeling at home with, I urge you to apply. I always knew I wanted an internship before entering the “real” workforce, but I wanted to be able to make my contribution this summer matter—a place where I could make a difference, and HealthEdge gave that to me.