Under a New Administration, Payers Must Operationalize for Change

Under a New Administration, Payers Must Operationalize for Change

Current State

In March 2017, the Trump Administration proposed The American Health Care Act to repeal and replace the Affordable Care Act (ACA) and give Americans access to ‘truly affordable, quality health coverage.’ The proposed legislation was ultimately not presented for House vote, however, the Trump Administration remains committed to repealing the ACA and working with bipartisan leadership to propose new legislation. Although components of the legislation will likely shift, we can expect to see similarities between The American Health Care Act and new legislation. Furthermore, any changes to existing policy will ultimately result in downstream impact to payers.

Operational Impact to Payers

If components of The American Health Care Act are enacted under new legislation, payers should anticipate similar challenges as experienced while operationalizing the ACA. For example, payers should expect an increase in calls, emails, and communication from their individual books of business, particularly those who are most impacted, including low income individuals and older individuals who are not yet eligible for Medicare.

The financial and emotional impact on these individuals will be realized by payers in operations and customer satisfaction scores. First, individuals will contact payers due to uncertainty around the cost of care and their plan options. Call centers will field questions from individuals wanting to understand impacts to current plans, as well as new plan options.  Due to the proposed reduction in plan design limitations, payers may begin offering more plan options to individuals. Individuals may likely have even less clarity than they do today on plan benefits, resulting in visits to out-of-network providers and unexpected costs of care. Second, payers should expect billing disarray. Individuals who are most impacted by premium increases and reduced tax credits may struggle to pay premiums on time or stop paying altogether, even while their policies are active. In addition, payers’ billing processes must be streamlined and technology configured to manage the increase of billing non-compliance. Finally, payers should expect to see a drop in CSAT scores. The introduction of higher costs and more confusion within the marketplace will likely echo across commercial, government, and individual lines of business, continuing the trend of low customer experience scores.

Recommendation to Payers

To prepare for impacts from new legislation proposed under the Trump Administration, payers must (1) accelerate efforts to improve customer experience and (2) design with the customer in mind:

  1. Accelerate Efforts to Improve Customer Experience

Healthcare is a very dynamic industry now and for the foreseeable future. It is not enough for payers to plan on educating agents on a reactive basis (e.g. ACA modifications pass so now we train).  Payers must build operations and leverage technology that allow for near instant changes in information updates. Additionally, by creating a flexible staffing model to accommodate Open Enrollment surges and absorb sudden industry changes, payers will improve customer experience overall. Cross-training should be a continuous effort to ensure agents are able to handle a range of customer questions, and Key Performance Indicators should be identified based on the agent’s ability to serve the customer, rather than being held to a call time.

  1. Design with the Customer in Mind

The ability of payers to simplify service to members is a differentiator that will ultimately reduce operational costs regardless of changes in legislation. Innovation in self-service is a rapid way to reduce costs which, when done correctly, allows for A/B testing and an evolution of solutions. Creating operational efficiencies requires an upfront investment, but generally result in a future ROI and improved experience among internal employees and external members.

In addition, payers have the opportunity to continue efforts to influence consumer behavior. Specifically, how individuals consume health care for themselves and their dependents, especially within individual lines of business. With the added flexibility of product design under the proposed legislation, payers must push themselves to design products to deliver adequate coverage at an affordable cost to those individuals most at risk to lose coverage under the ‘repeal and replace’ scenario. Products should be differentiated, costs should be transparent, and the value proposition of their health plan clearly communicated.

Final Thoughts

Although there are many unknowns as payers prepare for the Trump Administration’s forthcoming legislation, we know that uncertainties uncover operational disarray and customer dissatisfaction. Regardless of how the Trump Administration approaches new healthcare legislation, payers must streamline operations and design around their customers to remain competitive in the market.

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