Blowing up the “Health Insurance” Service Model

August 1, 2011
|In Performance Optimization, Policy & Health Reform, Star Ratings
|By GHG Advisors

In the 15 months since ACA passed, MA plans have scrambled to improve their Star Rating. Nothing motivates like the promise of a 5% premium bump in an era otherwise marked by dramatic payment decline.  Also motivating: CMS appears to be making initial steps towards delivering on intimations that low-rated plans will have their contracts terminated.

Early efforts in the Stars focused on HEDIS scores and for good reason.  Much of domains I and II are process and outcome-based HEDIS measures.  But with C and D ratings taken together, less than 20% of the ratings are actually driven by these clinical targets.  So where’s the beef?

It’s the service model.  HEDIS aside, fully half the measures can be traced directly back to the service model— and we’re not talking call center hold times.  The reliance on subjective survey measures for much of the Star scoring and the role of the service center in driving member compliance with clinical activities point to the increasing value of the relationship members have with the plan— for better or worse.

This week, noted power point gurus Accenture released the results of a consumer survey regarding health insurance.  The report shows that nearly half of insurance customers would be willing to pay more for health insurance that caters to their needs.   Two specific items stood out to me:

  • 85 percent of those surveyed rated interaction with knowledgeable employees as highly important, yet fewer than 50 percent were satisfied with current experience;
  • More than 80 percent said dealing with one contact to resolve issues was important, but 60 percent said they currently were transferred to multiple contacts to resolve issues.

This sounds like the best very best rationale for the “Concierge” customer service model we’ve put in place at a few plans over the years.  In the Concierge model, every member is paneled to a specific Rep, who also is tasked with making frequent, targeted and data-driven outreach to their panel.  In other words, don’t wait until the customers are unhappy until you talk to them.  And while Concierge programs have proven to be no more expensive than traditional inbound models, this survey implies that your members would even pay more for it.