The Changing Role of Health Plans Centers Around Membership Engagement

May 17, 2017

The Affordable Care Act has changed the traditional ways health plans operate and serve their members. After seven years of sweeping changes, health plans have adjusted their services to be more consumer-centered. Now, the role of health plans centers around membership engagement.

Traditional vs. New Role for Health Plans

An article on Modern Healthcare called: “The health insurance industry's identity crisis”, written on Jan. 30, 2016 by Bob Herman, explains:

“It’s less about insurance companies being claims processors and more about facilitating care for people and their families...”

Engaging members, throughout their care journeys, is a central component to the new role health plans are adopting. A major reason why is because of value-based payments for Medicaid and Medicare programs, which are pressuring health plans to adjust their services for improved satisfaction ratings.

Another reason is because profit margins are smaller, which means expanded services and markets are necessary. The article explains:

“As a result, insurers are shifting their attention to taxpayer-funded coverage and finding ways to grow outside the bounds of traditional health plans, such as selling technology services.”

In an industry with over $800 billion in revenue, 459k employees, and 852 businesses (according to IBISWorld), change doesn't come overnight; yet, the emphasis on the types of services health plans provide their members has decidedly changed over the last 7 years (since the ACA impacted the market).

Membership Engagement Strategies

Providers and health plans have been focusing on developing solutions for improving membership engagement, not only to meet regulatory and funding changes, but also to meet their members and patients' expectations. Basically, patients and members are being treated more like consumers, and the care journey more like the “buyer's experience.”

Technology combined with innovative methods of outreach and care are giving health plans and providers the strategies and methods to improve membership engagement. Health plans, uniquely, have the best opportunity to engage members with prevention, education, and assessment services.

Initial, routine, and aftercare outreach efforts give health plans the chance to offer convenient and effective health risk assessments, screenings, information on benefits, and directions to navigate an optimal care journey. The strategies and methods used to take advantage of these outreach efforts are key.

When health plans partner with MedXM they'll be able to offer their members: in-home doctors visits, nearby retail clinic visits, access to a members' online scheduling portal, and support from a knowledgeable call center representative. From these convenient visits with members, MedXM will conduct comprehensive HRAs, screenings, and examinations for risk stratification, prevention, and further care recommendations.

Industry Growth and Health Plan Evolution

Change is a constant in the healthcare industry, yet with the right foresight and planning, health care plans can adjust and take advantage of these changes. The projected growth from the baby boomers is one foreseeable change, as the article explains:

“Medicare Advantage, perhaps more than any other federal program, has attracted the most interest because of the substantial revenue prospects from the growing numbers of baby boomers becoming Medicare-eligible. Almost 18 million people have a private Medicare Advantage plan, up from 10.5 million in 2009.”

The adoption of innovative SaaS and IoT technologies for patient engagement, automated administrative tasks, appointment acquisitions, and achieving better overall health care outcomes – are also part of the change. Online technology combined with innovative strategies are working to build a system that can accommodate the influx of new members and any shifts in payment models.

Health plans are evolving into more comprehensive services, with a focus on membership engagement and prevention. Reducing costs and improving member satisfaction ratings are the main ways health plans can increase their lowered profit margins and stay relevant to an ever-changing market.

MedXM partners with health plans to optimize their membership engagement efforts, with: innovative technology, a vast nationwide network of healthcare professionals and retail clinics, and comprehensive assessment tools. Our decades of industry experience, technological solutions, and effective personal touch methods will smoothly transition health plans into their new role. If interested in learning more please contact us today.

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