Maybe the way to make health insurance plans for small groups more profitable is to spend a lot more on service.
Make believe you are viewing the American health care system from outer space.
You’d see employees paying for coverage that neither they nor their employers understand. You’d see members who have been convinced to stay “in network”–but who don’t trust their carriers. You’d see carriers who are convinced that their members are out to get all kinds of unnecessary care, procedures, medications and treatments.
Meanwhile, there is tremendous churn: 60% of small businesses shop for new coverage every year.
Why not try to improve performance by reducing the churn?
Here are three ideas for how to achieve that goal.
1. Keep it simple.
Insurers always are reminding plan members that “in-network rates” mean you have to stay in the network or pay more out of pocket and that generic-only drug plans do not cover brand-name drugs.
But when members actually need care, all many of them understand is, “I’m paying, and you’re not covering.”
If small business owners have to spend time figuring out which benefits are covered by the plan, or helping employees cope with complicated structures such as health reimbursement arrangements and health savings accounts, that takes away their ability to focus on their business and on increasing their profits.
Some health insurers want small businesses to buy their coverage through a Website or an automated telephone system.
Maybe a better way is to devote the resources to send a team to brief group members about coverage details.
Yes, that’s more expensive than automating the enrollment process. But it can increase customer loyalty, and experience suggests that members who are clear about their benefits tend to be healthier members.
3. Offer one-stop shopping.
One of small group plan members’ loudest complaints about health plans is that they have to make 12 different appointments to check out a health problem and risk accidentally seeing an out-of-network provider each time.
Consider solving that problem by setting up outpatient centers that provide all the kinds of routine and urgent care that a typical patient might need under one roof. Offer endoscopy, imaging systems and efficient electronic medical record systems, and doctors who are all in the same network.
A center like that can improve the quality and convenience of patient care, increase employer loyalty, and save the health plan hundreds of dollars per member per year.