Affordable Care Act: How Health Insurers Must Compete


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Changes in the country's health laws offer upsides for proactive insurers.

Changes in the country’s health laws offer upsides for proactive insurers.

Health insurers: Are you ready to sell to individuals?

In the United States, under President Obama’s Affordable Care Act, health insurance marketplaces are due to take effect on Jan. 1, 2014. Previously known as health insurance exchanges, these marketplaces will offer standardized, government-regulated healthcare plans.

The exchanges are designed to strengthen consumer protections while reducing risks for insurers — any insurer who offers plans via the marketplaces isn’t allowed to turn down anyone based on preexisting conditions — by ensuring that no one gets to cherry-pick customers.

To date, the majority of health insurance has been sold to businesses. But with the introduction of health insurance marketplaces, as well as the Affordable Care Act’s requirement that all U.S. residents purchase health insurance, the market for individual health policies is set to spike.

CRM Mandate: Get Member-Centric

Selling health insurance directly to consumers is common in the United Kingdom. Even though all residents have free access to the National Health Service (NHS), people can purchase supplemental or private insurance from the country’s big four health insurers — Bupa, Axa PPP, Aviva and PruHealth — or smaller niche players.

In the United States, capturing the new-subscriber market will require health insurers to get more member-centric. In 2010, for example, I noted that to capture new customers, insurers would need to focus on streamlining their contact center processes, consolidating data, retooling systems to maximize member-centricity and controlling product proliferation, by keeping plans and options clear and simple.

Arguably, little has changed since I made those recommendations, except for the Supreme Court ruling that the Affordable Care Act’s requirement that all Americans must purchase health insurance will stand.

Affordable Care Act: New Business Opportunities

Accordingly, health insurers now have three opportunities for using CRM to better target, attract and retain new subscribers:

Growth: Increasing the number of people who subscribe to your health plans is a surefire way to boost the bottom line. But what’s the best way to sell to new subscribers — perhaps online, or via agents and brokers — as well as design effective incentives and create sales teams from scratch to sell your new offerings? For help, take a page from the pharmaceutical industry. After gaining FDA approval for a new drug, for example, Cloud Sherpas customer Vertex rapidly implemented a new CRM system to enable its nascent sales team to begin immediately selling the new product.

Efficiency: Imagine you double the number of subscribers to your health plans. Cue double the number of calls to your contact center. What’s the best approach for handling those types of increases? Historically, we’ve found that health insurers chronically under-invest in the customer experience. The better approach is to invest wisely in better agent development and coaching, and refine test service tier structures as well as service channels. Here’s the ideal: Every incoming call gets successfully resolved by the agent who picks up the phone, the first time.

Customer satisfaction: The Affordable Care Act will make it much easier for consumers to switch plans. Accordingly, the most successful insurers will be the ones that offer top-notch service, for which consumers are already willing to pay more. Accordingly, give subscribers a clear way to make contact and understand what your plans are offering. Provide great self-service capabilities. Finally, ensure that the first contact center agent they come into contact with rapidly resolves their questions and concerns — be that on the phone, via email or on a social network.

As that implies: Be where your customers are, which is also where potential subscribers will be researching what you offer. Today, that means maintaining a strong presence on social media channels.

Ready To Compete?

Good and bad examples of the above opportunities abound, especially on the customer-care front. Search Twitter for New York’s EmblemHealth, for example, and the insurer appears to be absent. Not so its customers:

Contrast that with Blue Cross and Blue Shield of Minnesota:

Going forward, as more people purchase health plans directly — instead of having to settle for the options their business has picked for them – expect the most customer-centric insurers to win. As a healthcare subscriber, would you want it any other way?

Republished with author's permission from original post.

Adam Honig
Adam is the Co-Founder and CEO of Spiro Technologies. He is a recognized thought-leader in sales process and effectiveness, and has previously co-founded three successful technology companies: Innoveer Solutions, C-Bridge, and Open Environment. He is best known for speaking at various conferences including Dreamforce, for pioneering the 'No Jerks' hiring model, and for flying his drone while traveling the world.


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