Reconciling the Great Health Care Consumer Paradox

Are health care consumers willing to change to get what they want out of health care solutions?

The Affordable Care Act (ACA) will introduce approximately 51 million people to the individual health care marketplace, 34 million who are currently uninsured and 17 million employees of small businesses.¹ As the individual health care insurance market expands, so do the challenges these health care consumers present. What is getting in the way of effective consumer engagement in health care solutions? Accenture set out to answer this question by asking 1,900 US retail² health care consumers about their health care needs and behaviors.

We found that health insurers have the opportunity to embrace the key elements of successful transformations that have been tested and proven outside of health care for years. How these elements are addressed and the relative energy and investment required will depend on the health insurer’s strategic objectives, where they are in the customer-centricity journey, the organization’s current capabilities and its capacity to change.

Removing these barriers will require a coordinated, purposeful change agenda that takes into account people and processes, as well as technology. By reconciling the new health care paradox, health insurers can be better positioned to achieve high performance.

_________________________

1. Mannatt Health Solutions, 2012. The Supreme Court Decision on Health Care Reform.

2. Retail health care consumers are defined as consumers under 65 years of age who are uninsured, have individual coverage, or insured through their Small Group Employer (<100 employees). These consumer groups are widely assumed to make up the majority of the individual health care marketplace by 2014.

Today’s health care consumer mix is diverse and therefore represents a wide range of needs and behaviors. According to Accenture experience, individually insured members contact call centers up to six times more than employer group members. Other research shows that nearly one-quarter of uninsured adults go without needed care due to cost, compared to only four percent of those with private insurance.

The uninsured are at higher risk for preventable hospitalizations and for missed diagnoses of serious health conditions. After a chronic condition is diagnosed, they are less likely to receive follow-up care.³ The newly insured are 32 percent more likely to go to the emergency room than continually insured consumers.⁴

When these consumers enter the retail health care marketplace for the first time, it will be critical for health care insurers to engage them in making good health care decisions. In today’s marketplace, health care insurers are struggling with the right way to engage consumers. In fact, 57 percent of employers say that lack of engagement is their biggest obstacle to changing their employees’ health habits, however just 12 percent say their health care insurers are delivering effective engagement capabilities.⁵

_________________________

3. Kaiser Commission on Medicaid and the Uninsured, 2012. Five Facts about the Uninsured Population.

4. Archives of Internal Medicine, March 26, 2012 “Health insurance status change and emergency department use among US adults”

5. 17th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care, 2012.

Based on Accenture’s research, we have found that:

Retail health care consumers value affordability above all, but aren’t willing to make certain tradeoffs that impact health care costs. For retail consumers, their No. 1 concern with health care is affordability. Nearly three out of four retail consumers cite affordability as a bigger concern than access or quality of care, compared with less than half of non-retail consumers.⁶ The subset of the retail health care marketplace that is uninsured and eligible for government subsidy⁷ feels even more strongly, with 84 percent citing affordability as their chief concern.

Retail health care consumers are digitally savvy, but continue to demand live service from their health care insurer. Nearly three out of four retail health care consumers want a live person to answer their questions and resolve their issues, and only a third think it is important to have self-service options for resolving their own issues.

Health care consumers want guidance on improving health and wellness but aren’t following the guidance that’s given. More than three in four retail health care consumers say that the most important thing when receiving health care is help improving their health and wellness, and 65 percent need support and guidance after a major diagnosis or treatment. And although 81 percent of subsidy eligible health care consumers surveyed want help finding ways to improve their health and wellness, 40 percent of these same consumers don’t identify going to the doctor for regular checkups as a priority, and 26 percent say they do not do anything about their health until they are sick.

Read the full report to learn more detailed findings.

_________________________

6. Non-retail health care consumers are defined as consumers under 65 years of age, covered by Medicaid or insured through a medium to large employer group.

7. Subsidy-eligible consumers have incomes between 133 percent and 400 percent of federal poverty level in the 48 contiguous states, based on household size, estimated from the Congressional Research Services report, “Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA)” June 13, 2012

Accenture’s extensive experience with health insurers, as well as with leading customer-centric organizations in other industries, suggests there is a path forward to reconciling the consumer paradox. A customer-centric transformation will let insurers effectively engage retail consumers in smart health care choices to improve their health and save them money; solving the consumer engagement paradox and helping insurers build brand loyalty in meaningful ways.

This transformation is all about aligning a health insurer’s investments, products, services and processes with the needs of its consumer segments to maximize value. In health care, the definition of value may involve multiple dimensions including financial, health, quality of life and community outcomes.

Customer-centricity is a C-suite imperative, and for health insurers it requires new enterprise-level competencies that focus on knowing consumer needs and segments, tailoring offers, personalizing the experience across channels and empowering the organization to deliver relevant products.

Read the full report to learn about Accenture’s Customer-centricity Model.