AHIP: Payers Make Consumers Their Focal Point

Consumers cast a long shadow over this year's America's Health Insurance Plans Institute annual conference, with speaker after speaker advising insurers how to come to grips with the retail revolution in the healthcare industry.

When it comes to selling health insurance, employers are no longer the only game in town as individuals increasingly become their own purchasing agents on health insurance exchanges.

The shift from wholesale to retail was a dominant theme at this year's America's Health Insurance Plans Institute conference in Seattle June 11–13, with at least one speaker expressing a dire warning for payers.

"It's not coming; it's here. And if you haven't already started reacting, it's probably too late," Ingrid Lindberg, chief customer experience officer at Eagan, MN-based Prime Therapeutics, said after presenting her session on "Building Relationships and Driving Loyalty. "The world is cracking open and most people don't have a clue… People are scared."

The health insurance industry is in danger of suffering the same fate that befell pension funds, said Lindberg, drawing a parallel to how after passage Employee Retirement Income Security Act of 1974, the financial industry moved slowly, but surely, from a wholesale model featuring employer-sponsored pensions to a retail model dominated by 401(k) retirement plans.

The pension firms that failed to adapt paid dearly. "None of those companies survived," she said. "Just look at how much faster [healthcare] is moving. It took 20 to 25 years to unfold in the finance industry. It's going to take about 10 years in healthcare."

Lindberg said health insurance companies must have a strategy to fend off or co-opt new entrants to the market such as Wal-Mart, because experienced retailers have the potential to deliver a superior customer experience. "People have no tolerance for things that don't work for them."

Another speaker at the AHIP conference is a leader of one of the customer-oriented new entrants seeking to disrupt the health insurance industry.

Kevin Nazemi, co-founder of New York-based Oscar Insurance, said his company is taking a retail approach to selling policies on The Empire State's new public exchange. "This is an effort to take parallels from the consumer service world," the former Microsoft marketing director told conference attendees. "We try to explain to you in simple language what you are signing up for."

Oscar's website seeks to break several standard health insurance industry molds. One marketing slogan Nazemi highlighted during his presentation drew howls of laughter from the audience: "Health insurance that won't make your head explode. And if it does, you're covered."

The site features a "care router" search engine that helps members find doctors for specific conditions such as asthma, including breaking down the out-of-pocket expenses for seeking care in different settings.

It also tells members "what's likely to happen" at each setting in terms of tests and treatments. "This is a sense of empowering the consumer," Nazemi said.

Engagement as 'Game Changer'
Engaging consumers is essential for insurance companies operating on the new public and private health insurance exchanges, several AHIP conference speakers said.

"This is a game changer for all of us," said Scott Leitz, CEO of MNSure, the public exchange in Minnesota. "This is a retail business."

Andrew Grossman, a consultant who has worked with Connecticut's public exchange, Access Health CT, told conference attendees that exchanges require a commitment to conduct in-person outreach.

"It's the hardest audience in the world to deal with," he said of individuals purchasing health insurance policies on the public exchanges, many for the first time in their lives. "The only way to do it is to offer direct, face-to-face support."

Grossman said direct support for Connecticut's HIX consumers came in many forms, including town hall meetings as well as grassroots efforts at fairs, festivals and concerts. Promotional materials are ineffective if they are overloaded with legal jargon, he noted. "There has to be a little give in the direction of marketing."

Consumer education is a key factor for public and private exchanges, according to Grossman's co-presenter, Rick Johnson, a director at JD Power & Associates.
"The days of being able to just market to employers are changing," he said.

Harnessing Data Analytics
Insurers need to use data to get to know their individual customers and understand their behavior, said two other conference speakers.

"Humans, particularly patients, are weird, socially driven animals, and it's hard to predict what they do," said Dan Wagner, CEO of Civis Analytics. "Using individual information allows you to develop predictive capabilities," said Wagner, who is credited with helping President Obama to utilize data analytics as a revolutionary political campaign tool.

Wagner's co-speaker, Inovalon CEO Keith Dunleavy MD, said many of the vendors present at the AHIP conference are offering ways to utilize data analytics for consumer engagement. "The driving force behind all of them," he said, "is individual data."

Star Ratings
Establishing a direct connection with consumers is one of the keys to attaining high star rankings in Medicare quality programs, according to the speakers who led the AHIP conference session on "Mastering Medicare Star Ratings and Quality Initiatives."

The personal touch matters when working with consumers, said Ghita Worcester, senior VP for public affairs and marketing at Minnesota-based UCare. "If it's a human being and not a robo-call, we generate high satisfaction from our members," she said of customer outreach efforts.

Stephen Perkins MD, medical affairs VP at Pittsburgh-based UPMC Health Plan, said his company uses mobile clinics for diabetes patients and mammography screening to help providers reach consumers who face obstacles to staying compliant with their medical care.

"We will set this up close to a physician's office," he said. "It has significantly improved [compliance] rates, particularly in rural areas."

"The secret sauce is patient engagement," said Eliza Ng MD, medical affairs VP at New York-based EmblemHealth, who participated in a session on population health.