This year, health insurance will deliver a low-risk, high-reward, and ultimately exceptional member experience, while reducing costs and improving data quality, with a smart “no regrets” approach to the enrollment process. You should focus on your investment.

This year’s open enrollment offers a glimpse into what healthcare will look like in the next decade. Although COVID-19 cases have dropped significantly since 2020 or 2021, there is still uncertainty in the healthcare market going forward.

Will consumer over-focus on health and wellness extend beyond the pandemic, leading them to opt for plans that offer more robust wellness packages? will rejoin the workforce with a focus on providing innovative health insurance for families? Will inflation affect consumers’ priorities when choosing health insurance?

Now is not the time for health insurance leaders to sit back and see what happens to the market. Relying on outdated enrollment handbooks and a “business as usual” approach will set your health plan behind your competitors. Instead, the plan is to make sensible “no regrets” investments in the registration process that offer lower risk, higher rewards, reduced costs, improved data quality, while ultimately delivering a superior member experience. need to focus.

Create on-demand consumer experiences

The pandemic has accelerated the consumerization of healthcare. For example, at the height of the pandemic, consumer telemedicine use was 78 times higher than during the same period pre-pandemic. Today, telehealth usage is still 38 times higher than he was before the pandemic, indicating that consumers are getting care at their convenience.

Similarly, consumers today want an on-demand registration experience. While we are still holding our breath as to when members will be able to create their own enrollment packages, health insurance is poised to invest in digital transformation to improve transparency of processes and enable more customers. You should look for opportunities to enhance the consumer’s onboarding experience with a focus. central experience.

Implement intelligent workflows
Health insurance’s ability to innovate is greatly enhanced by the quality of data captured about members during open enrollment. Health insurance, which relies on legacy registration systems with little operational flexibility, advances other functions of the business, such as value-based care programs, population health, proactive outreach, and risk adjustment capabilities The opportunity to collect meaningful data is lost.

By adding a layer of intelligence, we can ensure that registration data is accurately captured, deciphered, enriched and organized. This also greatly reduces the need for manual registration file management, reducing the risk of costly and often published data errors. Data errors can cause problems in determining coverage and adjudicating claims.

Prepare for another strong public exchange registration
By January 15, 2022, 14.5 million people had registered on the market, according to the Department of Health and Human Services. This is the best ever.

Health plans competing on state exchanges this year should prepare for another strong market registration. why? First, the state registration period has been extended due to the pandemic, so there are more plans in the market to try to compete. People will shop on location and churn will be higher. Health plans must differentiate themselves by leveraging data to tailor their offerings in combination with innovative pricing strategies. Finally, the pandemic has increased consumer awareness of personal health care, with more people joining exchanges to ensure they are covered.

As there are still many uncertainties about the future of healthcare in this new era post-COVID-19, healthcare plans are pursuing strategies focused on digital transformation to make purchasing processes more consumer-centric. enable, increase efficiency and scale. Health insurance plans that succeed this admissions season will ensure an improved member experience, improved data quality and modernized technology while maintaining the flexibility to adapt to growing business lines such as state exchange programs. Focus on proven investments that

Aaron Fulner is Senior Director. Edifex It focuses on insurers involved in commercial, Managed Medicaid, Medicare Advantage, and dual eligibility programs.

Trey Keller is Vice President of Product Management for the Consumer Registered product line. Edifecs leads all product strategy and development for a range of products targeted at the healthcare registration space.



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