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The promise of direct-to-consumer solutions – think: wellness incentive programs – is great. Most operate under the theory that members who are actively engaged in maintaining their health will be invested in achieving better health outcomes leading to fewer doctor visits and ultimately to lower costs. This study thoroughly debunked that theory, finding that wellness programs had zero return on investment. (The study specifically examined wellness programs in the workplace, but the results are so clear that they can and should be applied to health plans.)

The proof that wellness programs aren’t helping is seen clearly each year in the November-to-March timeframe. This is the time of year when member engagement is the hardest as deductibles have reset to their annual maximums, and open enrollment is usually in full swing. Wellness programs have little ability to ease the friction members feel when they don’t understand how their plan works, how much to pay their providers or how to pay their recurring premiums. Instead, members are calling, emailing and posting on social media to their health plans for answers.

There are real solutions out there that can help payers to enhance the member experience. Here are some common member problems, solutions that help and data to prove the value.

“I went to my provider recently and got an EOB saying how much I may owe, but I haven’t received a bill yet. Can you help me understand how much I actually owe and how it affects my deductible?”

  • When a member receives an EOB with payment information but must wait for their provider bill, it can be difficult to understand how much they owe and the impacts on deductibles. Not having deductible information readily available can be frustrating for any member. However, for members who must see multiple providers in a short period of time, it is especially stressful to manage healthcare payments without real-time information about changes to their deductible.

When payers connect members to providers for payments through their portal, members are not only able to pay their responsibility sooner, but they can also immediately see how that payment affects their deductible – saving them a call to the payer.

Members want financial responsibility information and payments functionality in the health plan’s portal:

  • 69% of consumers are confused by EOBs and medical bills
  • 82% of consumers want to pay all their healthcare bills in one place

“My provider said you still haven’t paid their claim. They keep calling me about it. I know the visit is covered. Can you please hurry up and pay them?”

  • Providers all seem to have different ways of doing business. Sometimes, providers get members involved when the provider hasn’t received a payment for a claim – whether payers like it or not. Once the member gets that information, it’s reasonable for the member to think the provider won’t see them again until the payment is received. This is an extremely stressful situation for the member, and it’s likely the member will take it straight to the payer.

There could be any number of reasons why a provider payment is held up. The usual suspect, though? Paper EOPs and checks to providers. These payment methods cause significant payment processing delays, including depending on providers to receive and process the payment. Payers are reliant on the provider processes in this part of the member relationship. However, payers can switch to fully compliant CAQH CORE Phase III ERA/EFT transactions to ensure payments are automatically received in just days. This won’t completely eliminate this type of issue, but it’ll ensure payers make every effort to streamline the process.

Despite what you may have heard, providers don’t want paper either:

  • 84% of providers received paper checks and EOPs from one or more of their payers
  • For that same group of providers, 84% preferred to receive payer payments via ERA/EFT

“My premium is due soon, and I don’t want to lose my coverage for not paying. How can I pay my premium right now?”

  • Premiums are the most critical touchpoint between members and payers. If that payment process is confusing or simply not convenient, members are less likely to pay on time or even at all. When premiums aren’t paid, members are at risk of losing their coverage and likely will call their health plan either when they realize their coverage is at risk or when they’ve already lost coverage. Worse still, members could lose coverage without the payer ever hearing from them. That’s a lost relationship that the payer may never get back.

Payers can avoid almost all of the call volume and attrition related to the premium payment process by offering a retail-like payment experience. This means premium payment functionality that promotes electronic, online, self-service and automated payment options.

Not sure if your members want to pay this way? The data is pretty clear that they do (regardless of their age):

  • 78% of members prefer to pay their health plan premiums via online payment channels
  • 64% of consumers prefer the option to schedule an automatic deduction to pay their premiums
  • 89% of consumers prefer an electronic payment method when making premium payments to a health plan

 “I just got three paper statements for my premiums. Which one do I pay?”

  • To stay competitive, payers are developing more comprehensive, attractive benefits packages that include health, dental, wellness and vision plans. Members may not realize, however, that each of their plans is billed separately and they can be confused when more than one paper statement shows up from the payer. Often, this results in some type of inquiry about what each statement means and if they should actually pay all three. With the yearly influx of new members during open enrollment, payers are at risk of being swamped with new members’ calls.

The above data regarding how members want to pay their premiums applies here too. Payers probably already know they have to fix this premium problem but might be at a loss on how to do it. Offering a consolidated premium experience doesn’t have to be complicated. Learn more by checking out this short video and comprehensive eBook.

All of the data in this post can be found in the Trends in Healthcare Payments Eleventh Annual Report: 2020.

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