The Rising Trend of Consumer Choice and What Members Want More Out of Their Plans

Most Health plans and much of healthcare, overall, have had their feet on the gas when it comes to more patient-centered care or consumer choice services. COVID-19 has clearly made it all about the consumer in many ways, but more specifically, in making care much more accessible.

Patty Hayward, vice president of industry strategy for healthcare and life sciences at Talkdesk addresses the rising trend of consumer choice, what members want more out of their plans and how more payers can change operations to continue serving their consumers.

“‘Consumerization’ in healthcare has been a buzzword for years now,” Hayward said. “It’s taken for granted that the entire care landscape is adapting to shifting expectations. But a number of key trends has given more direct meaning to consumerism for payers specifically.”

She noted some of these trends include employer health plan members are twice as likely to be in a high-deductible plan than they were a decade ago. Price transparency is now the law for providers and is becoming more common in disruptive pharmacy offerings. In addition, care options using new delivery models, including many owned directly by payers, are spreading rapidly and drawing more and more patients. The rise in Medicare Advantage continues with no signs of slowing under the new administration.

“People are pushing back against the traditional care delivery and payment system,” she said. “Consumers are not satisfied with black box pricing and payments, and they expect to shop for important healthcare services with the same ease and access to information that they experience in less-critical aspects of their lives.”

She added consumers want more out of care than they’ve been receiving, such as more information, further patient-engagement 24/7 – however they wish to access it.

Through consumer choice, members and patients can personalize how they access and receive care. Providing members with the flexibility to opt for new or different care delivery models helps make healthcare more accessible in communities and demographics that have traditionally been underserved, Hayward said.

For instance, some populations are more likely to get care virtually or in a clinic, at a pharmacy or grocery store. There has also been improvement in how and to whom plans can offer supplemental benefits to address chronic conditions. She added payers are increasingly able and willing to proactively manage the care of more members at scale. Another example includes high-risk members who have gotten more individualized care plans for years.

“Now, many plans are looking more at social determinants and what drives health activation across large and diverse populations and finding ways to drive better health choices by offering more relevant healthcare options to more people,” Hayward said.

Consumer choice-focused care has a much higher chance of saving costs for patients depending on how they’re accessing care – if they choose through a telehealth channel of their choice to directly visiting urgent care or the ER.

“Cultivating a more engaged member population will reduce healthcare costs because those members are far more likely to do the right things for their health, whether that’s getting more exercise, taking their medications, or eliminating unhealthy habits such as smoking,” she said.

Lastly, there are also ROI drivers for member experience. With that being said, CMS has made CAHPS scores for Medicare Advantage the single most important part of the plan’s overall star ratings - which have major impact on reimbursement and bonus payment rates. As plans deliver better customer service, help members get care they need quickly, and execute strong care coordination will have a direct impact on payers’ bottom lines, also.

Hayward added health plan live agents have been under more stress than ever since the pandemic. This has led to a lot of agent churn, which can be very costly for plans. Providing agents with the tools they need to do their jobs better will lower their stress levels, improve their chances of success, and increase job satisfaction.

For payers to continue this approach and improve care for their members, Hayward encourages they engage more in proactive outreach.

For example, care managers rightly spend a lot of time on patients with three, four or five chronic diseases, while patients with less complex problems can fall through the cracks. One chronic disease statistically is likely to lead to two or more without interventions, she said.

“By engaging members more fully from the beginning, payers can guide them toward healthier behaviors and keep them on track with their care plans,” she said. “This proactive approach can prevent a chronic disease, such as Type 2 diabetes, from leading to kidney disease or retinal myopathy, averting unnecessary negative outcomes, and avoiding hospitalizations, surgeries and other expensive forms of care.”

“With the right tools and interaction platform, health plans can empower live agents to deal empathetically and proactively with members, accompanying them along their patient journeys and providing the optimal mix of outreach and self-service.”