Health plans must add or expand new business models quickly to take advantage of opportunities, drive competitive advantage, and retain membership. All health plans, no matter the size, continually address their business plans by expanding into new geographical markets, creating new products, marketing to new customers, or simply retaining membership by building satisfaction and loyalty. But to do it successfully, they must be able to answer the following questions before they launch:
- What benefit offerings will resonate with the market?
- How can the retention rate for existing business be improved?
- Will the group/member setup be completed on-time with high quality for processing?
- Does the provider community properly support improved health and low cost to the members?
In the years I’ve spent working directly with our customers, I’ve learned a lot about what they are worried about, what challenges they’re facing, and what keeps them up at night. While working with large regional health plans, here are some of the scenarios I’ve witnessed:
A regional Northeast health plan with Commercial, Self-Funded, Medicare Advantage, and Medicaid lines of business, added new provider contract and payment models, and implemented value-based payments, to align with the provider network. By doing this, they increased customer satisfaction and overall health in the community, as well as improved stakeholder engagement among members, employers, providers, and hospitals.
A Mid-West organization with Commercial, Individual, Medicare Advantage, and Medicaid lines of business, focused on speed-to-market and decreased time to create and launch a new benefit plan. As a result, they increased member satisfaction by simplifying account setup and enrollment and reducing errors.
Several customers have had to respond to providers and consumers embracing new care by offering patients a hybrid of telehealth and physical visits and enhanced mental health resources. With multiple options to deliver and receive quality, convenient care, it’s important that health plans design benefit plans that address consumers’ needs.
When all is said and done, I’ve come to realize that maintaining flexibility and the ability to respond quickly and correctly the first time not only enhances a payer’s competitive position but, in many cases, can save a regional plan. It has become binary. Have the ability and succeed, or not build the capability and fail. Happily, I’ve seen many chose to succeed.