Almost 40 percent of consumers who drop public HIX coverage choose to do so, usually for financial reasons, according to Accenture research. Yet fully 87 percent of these elective dropouts end up back in the system later in the plan year—with the same poor utilization habits and the same preferences for active payer support.
A more coordinated and targeted approach to meeting their needs would not only help retain them. Better care coordination and consumer engagement would also help healthcare payers meet the needs of other consumers with similar preferences, support health insurance exchanges in containing costs and contribute to building the long-term customer loyalty that sustains business success in the healthcare industry.
Elective HIX dropouts need help
Elective dropouts are significantly sicker than public HIX consumers who remain enrolled—and they have worse utilization habits. They are less likely to take advantage of preventive care (37 percent vs. 65 percent) or prescription drug services (37 percent vs. 61 percent); use the ER much more frequently (21 percent vs. 11 percent); have higher rates of chronic conditions and serious illness; and are more than twice as likely to need inpatient surgery requiring overnight stay. They are more likely as well to be interested in saving money by changing their primary care doctor (57 percent vs. 48 percent).
These consumers are considerably more interested than the overall HIX population in having their health plans be active helpers in their healthcare decision making (33 percent vs. 14 percent). But they need plan designs and services that are tailored to their individual preferences.
A strategy for active engagement
Actively engaging these consumers early in their coverage would benefit both payers and public exchanges.
Access to wellness programs and similar interventions soon after initial enrollment could induce the elective dropouts to make more efficient use of services, including preventive care. Exchanges, too, would benefit, since consumers who use healthcare more efficiently help keep down the costs that drive future premium increases.
Convenient services geared toward support and guidance could also benefit other consumers new to insurance. Since 36 percent of all public HIX consumers would accept a narrower network of doctors to save money, smaller, provider-centered networks could be critical enablers; helping get consumers into preventive care sooner, for example. What’s more, a strategy for active engagement could help retain consumers as they move across the markets in which insurers’ plans are offered.
By building an integrated, context-driven, personalized and digitally enabled user experience platform, healthcare payers and health insurance exchanges could identify people who fit the HIX dropout profile soon after initial enrollment. It could help highlight risky health conditions sooner, for example—before the consumer turns up in the ER. And beyond driving better health outcomes, these highly personalized approaches to the customer experience would strengthen loyalty and retention.
By taking steps now to change the elective dropouts’ habits, reshape their behaviors and retain them, insurers and exchanges could achieve a win-win: for their customers, and for themselves.