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Payers can strengthen consumer focus in 3 steps


Insurers are striving to provide more than only coverage of healthcare services to survive the shift to a consumer-focused business. They now aim to offer an overall experience for consumers and become a more integral aspect of their daily healthcare decisions, reported Managed Healthcare Executive.

Managed Healthcare Executive explored five steps insurers can take to become more consumer-centric. Here is a breakdown of three of those approaches:

1. Define quality in terms of convenience

Consumers now define quality in terms of convenience, so insurers should aim to provide "resources and information that help simplify and improve their healthcare experience," Aetna spokesperson Ethan Slavin told Managed Healthcare Executive.

Aetna, for example, offers consumers tools like its member payment estimator, which helps members compare prices for health services; its iTriage app, which allows consumers to check their symptoms; and its CarePass platform, which offers access to health and wellness mobile apps. These tools help consumers make better healthcare decisions, which often leads to improved outcomes and lower costs, Slavin said.

Likewise, Pittsburgh-based Highmark has its own cost transparency tool that allows its members to see estimated prices for medical procedures, as well as compare and rate doctors and medical facilities.

2. Optimize member communications

The health insurance industry is known for confusing jargon, something that doesn't lend itself to being consumer friendly. "We found that most people think that coinsurance is 'insurance for me and my spouse,' that the provider is the insurance company, and EOB is the 'This is not a bill' letter," Matt Manders, president of regional and operations for Cigna, told Managed Healthcare Executive.

In fact, America's Health Insurance Plans has said almost nine out of 10 adults have trouble using health information to make informed decisions about their health.

So, insurers need "softer ways" to communicate with members, according to Managed Healthcare Executive. "Describe the concept before tagging it with its official name, and do so repeatedly in all forms of communications--telephone, mail and web," Schneider said.

Cigna has done just that. "We've taken these learnings and socialized them throughout the enterprise so that we can better connect with our customers by using simple, clear and common-sense language," Manders said.

3. Enhance provider relationships

Insurers have loads of data that, if shared appropriately, could enhance their relationships with providers and help produce better healthcare outcomes. That's why Aetna shares its data with doctors and hospitals that partner with it in accountable care organizations. The information helps empower these providers to "manage the care process in a convenient, high-quality, low-cost way," Charles Kennedy, CEO of Aetna's accountable care solutions, previously told FierceHealthPayer.

But there's a caveat. "The information must provide physicians with a better understanding of their patients' diseases and how their treatments positively or negatively affect results; how it can mitigate their malpractice risks; and, how it will increase practice profitability, through efficiencies that are qualitative and which are the most cost-effective," Joseph Mack, president of business healthcare advisory Joseph Mack & Associates, told Managed Healthcare Executives.

It's also worthwhile for insurers to proactively advise members about their choice of providers and treatments. UnitedHealth, for example, is taking steps to connect its members to the right resources for them to reach optimum health, whether that be financial, clinical, wellness, social or caregiving resources.

To learn more:
- read the Managed Healthcare Executive article

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