Lessons from the Health Insurance Exchanges, so Far

Guest post by John Shagoury, President and CEO, Eliza Corporation

Number of people newly enrolling in health insurance: an estimated 8 million.

Number of new members who have yet to pay their first month’s premium: about one in five.

Number of lessons learned so far from the exchange marketplace: countless.

Whether you’re shopping for insurance for the first time, steeling yourself for an influx of new members to your roster or wondering how our nation as a whole will weather this historic moment in health care, the current exchange environment offers unprecedented opportunity — as well as risk.

While much of this is new to us, too, we do bring some perspective (in the form of more than a billion interactions with real people) into how data can help predict how consumers will engage in their health and benefits, and the communication strategies that help them make better decisions about their health. We share some of these insights below.


Address health literacy early and often: A recent article in The Atlantic cites that 35 percent of Americans — particularly among groups who are eligible for coverage under the new laws — have only basic or below-basic health literacy. For health plan clients, low health literacy results in member frustration, flooded call centers and dissatisfaction with brand. We’ve seen it in our own data, too. In outreach to people about their coverage, we found that more than half of members who only needed to return a form to keep their insurance admitted they couldn’t find the form. Meanwhile, 75 percent of members who were offered a transfer for more information about their coverage accepted it, and 67 percent of those asked said they intended to mail that form in before the deadline to keep their coverage. It just took a proactive nudge to get them there.

Use data to predict outcomes: In this new environment, health care organizations need a new way of understanding which segments of the population will need the most help, most urgently. We’re helping them leverage data to make those predictions. For example, our Vulnerability Index — which identifies members who are struggling with life context issues such as caregiving or financial stress — is powerfully predictive of health status. People who rate high on this Index are 2.6 times more likely to have diabetes-related claims, four times more likely to be in the highest 5 percent of spenders and 23 percent less likely to give their plan high satisfaction marks.

This unique data asset lets our clients target their most vulnerable members before the first claim or satisfaction survey comes in — helping them prioritize preventive health outreach or promote helpful resources such as an Employee Assistance Program. Many first-time members may not even know about resources like these, which may not only boost participation but also add value to the organization in the eyes of these new members.

Become a trusted advisor: Building a relationship — especially with people who are new to the market — takes time. In our experience, though, the health care organizations that commit to delivering consistent, relevant information when and how people need it most — whether through proactive phone calls, mobile messaging, social networking, live agents who know the ins and outs of the system or another outreach channel — enjoy better outcomes.

For example, we help our health plans develop communication strategies that engage people at key points on topics like preventive screenings, condition management, satisfaction surveys, adherence, post-hospital discharge, emergency room utilization and other topics that a health care organization’s success is measured on. Results include higher preventive screening rates and lower operational costs as people make smarter utilization choices. Perhaps most telling, one of our clients saw an 85 percent increase in Net Promoter Score over baseline after launching personalized outreach around women’s health.

Whatever your role in this new marketplace, the risk is great. But for those organizations that take a data-driven approach and engage people in meaningful ways over time, the rewards in terms of happier, healthier populations are even greater.
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Eliza Corporation (“Eliza”) is devoted to making people happier, healthier, and more productive. The pioneer and recognized leader in Health Engagement Management, Eliza draws from more than a billion interactions with people about their health, and blends business intelligence, technology, and communication expertise to improve care experiences, reduce costs and advance population health.

Each program is powered by Eliza’s engagement-based analytics and population segmentation, and delivered via our patented speech recognition technology, rich web and multi-channel delivery platform (including automated calls, emails, text messages, mail, social and mobile interactions). These programs consistently yield the best outcomes in the industry in terms of increased engagement, health and wellness measures, and sustainable ROI.

For more information, please visit Eliza Corp's website.

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