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Improving the member experience, as we’ve previously discussed, is paramount in today’s health insurance market. Regardless of your niche or business model, how you connect with your members will pave the road to success. With constant changes in federal regulations, state-based guidelines, and customer demand, as a provider, you’ll likely be precision focused on identifying key areas of improvement. Communication is an ideal channel for member enhancement, and in our recent White Paper, we share some of these best member-experience practices. As you explore your many options, here are a few critical improvement methods you should consider leveraging today.

Enhanced Direct Enrollment Is a Pivotal Step Forward

If you’re not yet exploring opportunities with Enhanced Direct Enrollment, you could be missing out on a pivotal step forward. In our recent Whitepaper, we uncover many of the technological initiatives needed to continually improve your system and implement advancements such as EDE.

Although EDE’s primary goal is to provide enhancements for consumers and families to shop and enroll in a health plan branded environment, it also pushes the private sector to develop by providing a real-time framework that accesses the CMS “backend.” Ambassadors are creating and certifying EDE shopping platforms that go far beyond the current consumer engagement.

The simplicity of the original Direct Enrollment and its expanding functionality are two reasons it is still popular today. However, because of advancements in technology, direct enrollment has expanded beyond simply enrolling individuals into a health plan to an all-encompassing benefit shopping and policy management portal that consumers use year-round.

Partnering with Softheon, for example, will allow you to lean into the EDE API-based ecosystem and work with CMS in real-time for an exchange of data in a seamless platform. As a result, member experiences will improve exponentially as they easily access their information, make changes to their existing coverage situations, and enroll in new policies without concern. When individuals and brokers have the control to review documents, set up preferences, and renew policies, everyone wins.

EDE will use CMS as the system of truth for eligibility validation, but the logic presents in real-time via message rather than file-based services. EDE becomes the consumer’s health plan branded all-purpose Marketplace engagement portal for keeping their coverage.

To learn more about a standalone EDE solution, contact our subsidiary, W3LL.

Getting into the ACA Marketplace

Because today’s consumers are accessing various segments for their health insurance needs, as a provider, you should be looking to enter the ACA Marketplace. If you’re already exploring ACA Marketplace offerings, you can improve member engagement via communication efforts.

Our recent Whitepaper highlights some of the strategies available to you now. The passage of new legislation and an increase in subsidies, as well as increased interest in the ACA, led to a surge of new and returning enrollees.

Insurers are also reentering the Marketplace because of improved stability, which has opened up new business possibilities. As industry leaders expand their offerings on the Marketplaces, health plans may do the same and profit from this niche, but they must first place themselves in a position to achieve faster development.

This insightful and Softheon-initiated report highlights what health plan providers should be doing to capitalize on this unique opportunity. Some of the critical areas of communication improvement include the following areas of expansion and enhancement.

  • The automation of both DOI and CMS compliance regulation guidelines is important to help members understand what new rights, benefits, and premium tax credits are available to them.
  • There are new ways to increase member satisfaction with the use of various payment protections for online transactions.
  • New technologies are available to improve member communication by developing comprehensive platforms allowing for streamlined engagements and reconciliation.
  • To benefit your process, leveraging these new technologies will allow more efficient administrative functions, reducing overhead and providing a better user experience.
  • Tapping into the ACA Marketplace now is only half the journey. Improve communications and member experiences by also developing a scalable model of engagement to embrace changes in the future.

Transparency & Authentic Member Engagement

We’ve discussed before the importance of transparency for improved member engagement. This logic is applicable in the Marketplace but also across all enrollment touchpoints, including Medicare customers and private market insurance shoppers, as well. The data already points to distrust of the insurance market among consumers. These misconceptions come from years of less-than-transparent industry practices and poor user experiences. However, today’s methods, channels, and technology are redefining how individuals access their information across the board. Dispel myths about disinterested providers and disconnected support by focusing on authentic communication strategies throughout the year and the entire member journey.

Planning year-long customer interactions will help you leverage company touchpoints throughout the plan year. Insurers should be vigilant in identifying when a consumer may require assistance and designing effective customer service procedures for each need. Avoid missing out on an opportunity to have an exchange or give a supplementary service advantage.

There is still somewhat of a gap between customers and their insurance providers. According to some statistics, one in three people does not feel that their providers would “do the right thing.” Customers have a cloud of suspicion over their selected companies and coverage. Insurers may seek innovative ways to foster friendly, open, and honest interactions in order to remove the fog of suspicion or distrust.

To keep clients involved in their insurance processes, provide more of the information they want most online. Ensure that business-wide best practices for communicating with enrollees who need assistance are paramount. And many of the most successful insurers employ a layer of follow-up care to guarantee that customers are pleased with the answers and services they receive.

For health insurance providers who are looking to enter the ACA Marketplace, improving member experience through communication is critical. Key considerations for increasing satisfaction include transparency and automation of DOI and CMS compliance regulation guidelines, new ways to increase online transactions (e.g., payment protections,) and improved communications via robust platforms that allow streamlined engagements with reconciliation tools. If you’re interested in exploring even further about how your company can improve member experiences in advance communication strategies, check out our recently published Whitepaper or contact us today!


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Key Areas to Improve Member Experience through Communication