Educate, Engage, and Relieve Your Policyholders of ACA Angst


Posted by Kenton Bohn - 27 June, 2013

By Ken Pedersen, Executive Management and
Kenton Bohn, VP & Healthcare Practice Lead


What makes the October 2013 Open Enrollment deadline so unique is that education and awareness about the upcoming health insurance exchanges aren’t confined to only those without health insurance. The level of concern and uncertainty regarding what the health insurance exchanges will bring is equal among both the insured and the uninsured.

As Open Enrollment fast approaches (we’re only 96 days away now), we’re all hearing about significant increases in the number of inquiries regarding the impact of The Affordable Care Act on payers, providers, policyholders and patients.

What’s most important about the dramatic rise in these inbound questions is that the inquiries aren’t being specifically asked to the payer. Rather, inquiries about policy coverage, health insurance exchange impacts, costs, etc., are being addressed to organizations and individuals throughout the entire healthcare value chain.

Why are these questions being asked throughout the value chain?

This is a great question because it strikes at the heart of the issue of policyholder education and engagement. For the first time, individuals and employers are facing a major social change – one that is presented to them 24/7. Just listen to the evening news, pick up your local paper, browse your favorite news sites or your Facebook timeline – people are deluged with conflicting opinions and facts about health insurance and the impact of the upcoming health insurance exchanges.

Additionally, for the majority of the residents in any state, health insurance, the exchanges and the cost of healthcare are serious economic issues that require serious attention.

In order to make the upcoming enrollment process easier, payers and providers need to play a very proactive role in communicating with and educating their customers.

Four Key Questions

In part one of our Fresh Thinking in Healthcare series, Five Ways Private Health Insurance Exchanges Are Paving the Way for Payers, we looked briefly at four key questions that payers would face regarding the upcoming insurance exchanges:

  • What are the key factors contributing to a delayed enrollment?
  • Was the process overwhelming? Is there too much information presented and/or required?
  • How can a prospective policyholder’s existing experience with online registration processes and wizards be leveraged to encapsulate this complex registration process?
  • What positive reinforcements and real-time help options are needed to keep prospective policyholders on track with their registration?

Since publishing the first piece in our series, we’ve learned that these four questions remain highly relevant for measuring the effectiveness of policyholder engagement within a health insurance exchange deployment. We’ve also learned that there are a number of additional, higher level questions that payers are going to need to be able to answer. Whether you’re looking to efficiently support a private or a public exchange effort, meeting the information needs of your policyholders and their providers is quickly becoming a paramount concern – and a competitive differentiator.

A Comprehensive Plan

In order to help our clients best understand these unique challenges, we set out to ask the experts – brokers working with businesses and their individual policyholders.

Here are the three most common questions we heard brokers were being asked:

  • What am I gaining or losing in coverage by shopping on the public exchange vs. accepting coverage from my employer?
  • How much more is my insurance going to cost if I don’t select a plan from a public exchange?
  • Is it going to be cheaper for me as an employer to not offer my employees coverage and instead subsidize their policy purchase from the public exchange and/or pay the fines?

On a state-by-state basis, hundreds of millions of dollars are going into awareness and education about the exchanges. This messaging is going to be singularly focused on those who are not insured, which is going to cause further confusion for those who are insured. One thing has become perfectly clear in the run-up to the launch of health insurance exchanges: As the messages become more ubiquitous, the confusion is going to increase dramatically, and the cost of supporting these inquiries is going to rise accordingly.

Minimizing Costs and Mitigating Risk

As a payer, what can you do to mitigate the risks associated with the increase in inquiries?

Business Challenges vs. Technical Challenges

First, it’s critical to recognize that the exchanges produce more business challenges than technical challenges. The fact that this transition is playing out in such a public forum means solving the technical issues associated with the launch of a private exchange or the support of a public exchange is going to pale in comparison to the challenges associated with sales, marketing and education. Equally important to technical exchange system and integration testing will be the training and testing of customer service staff to manage the new inquiries the exchange will cause. This training will require dedicated, up-front time from the IT group as well as the customer service team to optimize information flow and screen design requirements.

Consistent and Measured Communications

Second, formal policyholder and customer communications strategies need to be set, immediately. Your existing policyholders and business customers (employers) need to fully understand the impact your states’ exchanges and the Open Enrollment period will have on them (individually) and collectively (as employers). Do not underestimate the need for consistent and measured communications. The deluge of information already circulating is only going to increase as states begin spending the tens (and hundreds) of millions of dollars they have been allocated to raise awareness. These communications are not, on the whole, answering questions. Instead, as noted above, they are already leading their recipients to ask more questions than ever before. This reinforces the importance of your education and training policies as well as the criticality of maintaining ongoing testing of your communications to address the issues that are on the top of everyone’s minds during the run-up to Open Enrollment.

Everyone Is Looking for Answers

Third, recognize that everyone in the healthcare value chain (payer, provider, benefits management, pharmacists, etc.) is going to be looking for answers. The opportunity for payers to provide the information these key members of the value chain need is significant. The empowerment of these trusted partners to answer very troubling questions for your policyholders will go a long way to furthering the value chain and policyholders’ trust in your organization.

Respond Quickly

Fourth, note that the rollout of the exchanges is a marathon, not a sprint. Significant components of the Open Enrollment process and the exchanges themselves are going to remain in flux well past their “launch” dates. The ability to quickly respond to these issues and provide technology solutions/education in a consistent manner to the entire value chain and to policyholders is going to significantly outweigh the importance of being first or noisiest.

Setting yourself up for success with formal processes whereby solutions, processes and communications are regularly reviewed by all key stakeholders will be paramount to minimizing costs. Remember, it all begins with education and engagement.

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Topics: Business, leadership

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