Consumerization is here. Amazon is coming. Plans have to act more like the retail giant if they want to fend it off.

A friend’s employer recently rolled out a new high-deductible health plan with a pretty powerful incentive: $5,000 in cash for any employees who sign up.

That’s a fairly straightforward offer, and it sounds great. And yet my friend still can’t figure out whether her family of four should take it. Beyond the easy part — comparing $5,000 to the annual deductible — we’re trying to weigh the tax implications, the difference in provider networks, our family’s existing and potential health scenarios, how those might change and how to factor in the company’s other benefits, like health-saving accounts, wellness and telemedicine.

Compare that to the experience most of us have with businesses like Amazon or Costco or Netflix. When Amazon wants me to buy something, it sends me an email, hits me with a link on its site or shows me an ad. Amazon knows I want to buy it because I’ve searched for it, or I’ve bought it before and I’m probably running out. In fact, I may have already decided to buy it or realized I needed it myself. In any case, the decision is as simple as the two clicks it takes to make the purchase.

So if Amazon can remind me when we’re probably out of dog food each month, why doesn’t my health plan remind me I should get my annual physical? Wait, they do – they send a postcard every year. But it doesn’t reach me because all of the junk mail goes in the recycling bin. 

Of course, choosing health insurance for your family will never be as simple as buying dog food. But health plans can do much, much more to improve their communication in ways that make it easier to shop for and use health benefits. What if they had sent me a text? And if they don’t, someone else will.

That’s the reality facing today’s health plans. Thanks to digital-born companies like Amazon, expectations around customer experience have risen exponentially, while tolerance for frustrating experiences has plummeted. Banks, airlines, coffee chains and businesses in lots of other industries have responded by upgrading their digital customer experiences, building mobile apps and websites that help customers find what they need and purchase it with the least possible friction.

Health insurance remains an outlier. Many plans today offer digital apps for telemedicine or basic claims management, but few have introduced comprehensive tools to let members manage every aspect of their care, from understanding their benefits to choosing providers to filing and tracking claims.

The Communication Challenge

But perhaps more significant than new technology tools is the communication challenge. They have just as many good reasons to incentivize consumer behavior as banks or airlines, if not more: prodding members to take the next best action in their care almost always translates to lower costs over the short and long terms. If a smoker’s health plan could move her to try Chantix to quit smoking it could translate to millions of dollars saved on treatment for lung-disease or cancer down the road.

To do that, the plan should be actively educating and encouraging the member. That means identifying her as a smoker — likely using data drawn from her claims — then finding the most effective way to communicate to her, on her terms, when and where she will be receptive.

Maybe she rarely opens mail from her health plan but will open certain emails. Maybe emails referencing smoking in the subject line get opened but not acted on (in the form of clicking through and eventually getting the Chantix prescription), but when the subject line references financial incentives for smoking-cessation actions, she clicks through every time. If that’s the case, then the plan should focus on that communication channel, and that aspect of its benefits, in their communications to this particular person.

Building the Member’s Profile with Data

This kind of finely tuned communication requires careful analysis of the plan’s data, which requires analyzing the member’s response rate across communications channels — mail, email, text, etc. — and then adjusting based on the results. But it also means analyzing her every interaction with the plan. The plan needs to capture data every time the member logs into its website so it knows what pages she visited, what queries she typed in the search box, what brochures she viewed. Same thing when she dials into the call center or seeks authorization for a medical procedure.

By analyzing the data on a granular level, the plan can start to build a profile that reflects the member’s behavior, her preferences and her needs. From there it can understand how to effectively engage her and move her down the path of the most efficient, effective care.

Effective communication will also mean eliminating the clutter. If quitting smoking is the most impactful step she can take, inundating her with notices about flu shots or gym memberships is only going to make her more likely to ignore all the plan’s communications.

Focusing the member’s attention on the most impactful communications also requires more effective coordination and collaboration than many plans are capable of. At most plans various departments are competing for the member’s attention; the sales team may be focused on renewing members, while the marketing team is pushing new benefits and the claims department is pumping out billing records. Each department likely has its own goals and unique metrics for measuring them.

Meanwhile, none of them has access to the others’ data, so the care management team may not be aware that the member is a smoker, because the data that would reveal that fact is sitting in the claims department.

Effective communication requires a much more holistic view of the member, and a much more focused outreach strategy. Once again, getting there requires data mastery — the same kind of data organization and analysis that companies like Amazon use to detect our preferences and needs and then encourage and incentivize us to buy their products.

Of course, getting someone to quit smoking is a lot more complex and challenging than getting them to buy books and birthday presents. But that’s exactly why it’s so crucial for health plan leaders to aggressively engage their members in the most effective ways possible. For most, that will require partnering with technology companies that have the tools and the knowledge to implement solutions that work with — not in place of — the plans’ existing systems.

Those solutions are out there. The plans that move quickest to put them to work will be the ones most prepared to fend off the coming wave of competitors. Including Amazon.

You can reach out to Mark via his profile through our secure member portal.