Missing the mark
Today’s consumer-driven marketplace is challenging the fundamentals of health insurance product design and marketing. Health and wellness products are a case in point.
Insurers for decades have provided health and wellness products to meet employer demand. Employers believed in the cost-saving value proposition of health and wellness products, but due to fragmented and confusing approaches to defining engagement, effectiveness and ROI, there is growing doubt about outcomes.
Health and wellness offerings claim to deliver on the promise of managing healthcare costs by adhering to predefined care programs. However, insurers have missed the mark in demonstrating that these products reduce medical costs and effectively engage members.
Recent Accenture research revealed that 61 percent of employers were only "somewhat confident" or "not confident at all" on ROI claims. This lack of confidence in member engagement, usage of products and outcomes has contributed to employers turning to niche third-party solutions over insurer solutions—at a rate of 79 percent. Niche solutions are disrupting the health insurer relationship with employers.
Employer confidence in ROI claims
Engagement is critical
Medical cost return on investment (ROI) has become less convincing as a sales tool to reach employers. Employee engagement is more critical than ever in this consumer-centric, value-based, digital marketplace. Accenture survey results showed medical cost reduction as the third-highest priority at 79 percent, with employee engagement the highest at 84 percent and presenteeism at 81 percent.
Many health insurers have focused on keeping administrative costs low, assuming driving engagement is too expensive and produces limited results. Successful third-party solutions have focused on producing solid engagement results. This distinct difference in approach has contributed to the erosion of employer confidence in traditional product ROI.
Employers are thus more willing to explore engagement-focused alternatives in the hope they will result in better medical and presenteeism outcomes.
Successful engagement is modeled on a consumer-driven approach. Consumerism for health concentrates on engaging people at the right time (early) in the right ways (multi-channel) to achieve the right results (health and wellness). Engagement drives employees to receive care sooner, and avoid unnecessary emergency or critical care situations, leading to lower healthcare costs.
Employer priorities for health and wellness products
According to Accenture research, drivers related to program design/marketing are the reason why 66 percent of employees say they are not using health and wellness programs.
These drivers are "program not relevant/no apparent value," 40 percent; and "program is difficult or takes too long to use," 26 percent.
Insurers and third-party solutions typically take very different approaches to designing for engagement. The engagement approach most often taken by insurers is to add a customer service layer, such as outbound call centers and digital apps, without adjusting the fundamental product design or how it is marketed. This is the inverse of many third-party solutions that begin with a lens of engagement and build their entire offering based on maximizing the opportunity provided through each relevant engagement channel and interaction.
Drivers of lack of product utilization by employees
Meeting needs in new ways
Health plans can take these steps to close gaps in information and service capabilities to better meet the needs of today’s employers and employees.
STEP 1. Recognize the path to improvement is not just a new picture frame.
Health insurers must strive to treat the whole person. They can do so by bringing their clinical and product professionals together to create a flexible architecture where employees are involved in choosing from product options to create a plan customized for their individual situation.
STEP 2. See products through a new lens.
Use the consumer's perspective to shape offerings that increase engagement and interactions, leading to greater satisfaction. Patients will also gain the confidence to engage the health system earlier, and early engagement is a way to prevent later, more expensive claims.
STEP 3. Build a flexible architecture that defines products for usage.
A successful architecture connects the dots between provider, insurer, employer and employee by factoring in desired outcomes, governance, security, analytics, customer experiences, channels, people and technology.
STEP 4. Establish measurable targets.
Many health and wellness products are measured by participation rates. Insurers can measure success more comprehensively by linking participation in programs to outcomes.