Payer Solution

In 2017, U.S. healthcare spending reached nearly $3.5 trillion, or $10,348 per consumer, at a projected growth rate of 4.6 percent. Healthcare spending has become nearly a fifth of the nation’s total Gross Domestic Product (Centers for Medicare & Medicaid Services). This steady growth and large size of the industry make it a major economic driver for the country.

Whether the industry can sustain this size and growth are questions that remain unanswered. The answers, and thereby the future of the industry, depend heavily on consumers and their experiences in the industry. However, recent data doesn’t cast a promising outlook. Though the U.S. spends twice as much per person on average for healthcare compared to other industrialized countries (Kaiser Family Foundation), 75 percent of Americans say that the country does not get good value for what is spent (National Opinion Research Center).

The Problem: Ineffective Member Portals

Payers for their part are making strategic changes to better engage consumers in their healthcare experiences, such as investing heavily in member portals. However, these investments usually do not focus on easing confusion and, as a result, are ineffective in engaging the consumer. Only 21 percent of consumers regularly use their health plan’s member portal and only 30 percent of consumers were able to find an answer via the member portal without making a phone call (HealthMine). Anecdotally, many payers have reported member portal utilization as low as five percent.

Low adoption of member portals may be due in large part to their role in the healthcare journey. The portals are usually accessed when there are questions about payment responsibility for a healthcare encounter with a provider – often after an explanation of benefits and a medical bill are already received. At this late stage, member portals have little ability to impact a journey that is almost over.

It should be noted that some member portals do offer tools that could play a role in the beginning of the healthcare journey, such as searching for providers and costs estimates for services. However, these just give information that may or may not help make a decision. For example, a member may decide to choose a provider because of a peer recommendation with little consideration of the cost. These tools do not actually connect members with their providers by making appointments or payments and do not tell payers anything about the clinical decisions made.

The Opportunity: Provider Check-In

How can payers make member portals relevant to the healthcare journey and a useful tool in better understanding member behavior? The answer could be hiding at provider check-in. The current check-in experience includes filling out forms, verifying insurance eligibility and possibly collecting a copay, all of which are centered on benefit information. Yet, payers have no active role at this point – creating a missed opportunity for engagement.

Instead, payers can leverage the power of the smartphones already in their members’ hands to connect from the very beginning of their journey. For payers unsure of their members’ digital footprint, they need only look to the 77 percent of American adults who own a smartphone and report being online daily, as well as the quarter percent who report being online constantly (Pew Research Center).

Provider check-in is the first step in what can be a long and confusing journey for a member – both financially and clinically. With this advanced insight, payers can help members be better informed about their options, and better anticipate potential costs and outcomes.

The Strategy: Member BYOD

More commonly referred to as a “bring your own device” or BYOD strategy, smartphones are an opportunity for payers to leverage the access members already have at their fingertips. The data suggests that members want to connect in this way. Most notably, 80 percent of consumers want to check in for a provider visit on their own secure mobile device (Consumer Healthcare Payments Survey 2017).

For BYOD inspiration, payers can look to how the airline and hotel industries now allow travelers to complete the entire check-in process via a mobile app on their smartphone, which can be completed in just minutes and days in advance. If payers adopted similar technology, members could conveniently and easily check in for visits before ever stepping foot into their provider’s office.

Added Benefit: Provider Payment Assurance

In addition to improving the member journey, payers can also improve the relationship with their provider network by allowing members to securely save payment information for their payment responsibility at the time of check-in. In fact, 65 percent of consumers would download a mobile app to pay all of their healthcare bills (Consumer Healthcare Payments Survey 2017).

Most providers are dependent on income from their payer relationships, which payers leverage into deep discount arrangements. Payers consistently pressure providers with the risk of being removed from the payer’s network. However, this leverage is at stake as providers must rely on collections from members for revenue. Payers that ignore these revenue challenges for providers erode their provider network satisfaction, their discounts and ultimately their competitive advantage in selling health plan benefits to employers and members.

Money is at the heart of the relationship between payers and providers. The most significant way for payers to maintain and enhance their market and cost positions with providers is to return to what gave them the discounting leverage in the first place – payment assurance. (Read more about this in the Healthcare Payments White Paper for Payers.)

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