InstaMed Blog

When the public exchange was first introduced, it drastically changed the relationship between payers and consumers. Through Healthcare.gov, consumers are able to shop for a health plan, compare premiums between health plans and ultimately enroll in the plan of their choice.

This may not sound like a groundbreaking concept, but until the public exchange was introduced in 2013, consumers had little to no autonomy when it came to their health plan. Instead, insurance brokers and employer groups did most of the heavy lifting when it came to the payer-member relationship. Now, millions of consumers buy health plans directly from payers. (Read more about the relationship between payers and employer groups here.)

Though Healthcare.gov and the individual market have been around for years, payers still struggle to connect with consumers and build loyalty and trust needed to retain members year after year. The typical consumer engagement strategy includes some type of wellness-reward program or price comparison tool, but these solutions are known to have low adoption among consumers. That could be why 40 percent of payers still rank offering direct-to-consumer solutions as their top priority in 2017 (Payer Healthcare Payments Survey 2016).

Currently, most payer solutions for consumers answer the question: “what do consumers want from their health plans?” As a result, the solutions don’t have much relevance to a consumer’s day-to-day life – they’re really just nice to have. Maybe a better question for payers to ask themselves: “what do consumers need from health plans?”

So, what do consumers need from health plans? The new reality in healthcare is that consumers not only owe more, but the amounts are higher than ever before. Despite this shift, consumers are still in the dark about the healthcare payments process. Consider that:

  • Only a third of consumers understood their payment responsibility when a deductible or copay were part of their health plan (University of Connecticut’s Health Disparities Institute)
  • Only 7 percent of consumers could successfully define terms such as plan premium, deductible, co-insurance and out-of-pocket maximum (UnitedHealthcare Consumer Sentiment Survey)

The data clearly demonstrates a general lack of understanding on consumers’ part when it comes to their healthcare payment. However, payers don’t have to get consumers up to speed on the complex process that is healthcare payments or even ensure they have a deep knowledge of the associated terms, because all terms essentially boil down to the same meaning:

“You owe money and need to make a payment.”

What consumers really need from payers is the ability to easily see how much they owe and how to make a payment – regardless of whether it is a premium payment or claim payment. Payers can do this by integrating payment functionality within their existing member portals for all healthcare payments, where members can see exactly what they owe and easily make a payment in just a few clicks. The data shows that this is what consumers want from payers as 73 percent of consumers want to make all their healthcare payments in one place (Consumer Healthcare Payments Survey 2016). In fact, member portals with payment functionality have been shown to help increase consumer engagement by 10x, when compared to other direct-to-consumer solutions.

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