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Research and Discussion with a former Aetna/CVS Executive

Softheon joined Aetna/CVS and HCEG (Healthcare Executive Group) to discuss successful member retention strategies.

The cost of enrolling a new customer is seven to nine times more than retaining an existing one. How are carriers handling member retention efforts in the ACA marketplace?

Paul Wingle, the former Vice President of Individual & Family Plans at Aetna/CVS Health, and Kevin Deutsch, General Manager and Senior Vice President of Health Plan Cloud at Softheon, share how carrier-vendor partnerships are needed for a successful transition into the ACA Marketplace.

From termination predictions to improving self-service options, health plans need an effective retention plan to keep Marketplace gains. Improve health plans’ ROI by targeting retention efforts throughout the members’ journey.

Member Correspondence Falling on Deaf Ears? Lower Operation Costs and Improve Member Retention through Digital Engagement

Health plans in the ACA must adapt their consumer engagement methods to target this different type of enrollee.

Wingle highlights the struggles that Aetna faced transitioning from commercial to individual members. Health plans are no longer dealing with benefit specialists who have a deep understanding of the market. Health plans must prepare to do some extra handholding when guiding potential members.

Decision tools, consistent outreach, and healthcare education all help empower members to make their coverage a priority. The challenge does not end with enrolling individuals in coverage. Health plans must take proactive steps to ensure members stay enrolled.

A digital engagement strategy helps reduces operating costs while prioritizing ease of use. Aetna achieved a digital engagement interaction rate of 51%. Wingle shares initiatives that led to this increase in digital engagement.

Diversify Member Communication Channels

The use of various communication channels to target groups provides an additional level of personalization. Alternate between emails, direct mail, phone calls, and member portal interactions to reach most members.

Request that newly enrolled members share their preferred method of contact.

Just because a member prefers physical correspondence does not mean a health plan shouldn’t try to get them to engage digitally. Aetna includes QR codes on much of their physical notices to encourage use of their mobile app and other online offerings.

Find the Sweet Spot for Outreach Frequency

Health plans must toe a difficult line between keeping members informed and bombarding them with correspondence. Thorough consumer research will provide insight into what information your consumers want and the best way to deliver it.

Wingle supports the idea that less is more when it comes to member outreach. By keeping the frequency of correspondence low, health plans can cut outreach costs while ensuring relevancy.

New Aetna members receive a welcome kit with branded swag, benefit notices, and information on online services. Consumer research revealed the overwhelming interest in online support.

Other standard noticing includes payment reminders and invoices. Limit what’s included in the kit to information members need and want.

Besides welcome kits, future correspondence can be paperless based on members’ communication preferences.

Expand Self-Service Options

With the end of the Public Health Emergency (PHE) on the horizon, health plans relying on customer service representatives (CSR) will need to increase operations.

First-time ACA enrollees will have a lot more questions and needs. To keep members without scaling CSR, health plans need self-service options.

Enabling members to manage their coverage through an online portal or mobile app would help reduce backlogs.

Automating customer service with interactive voice response (IVR) can reduce call center backlogs. Members calling to do routine/simple tasks like resetting a password can navigate through interactive prompts.

Aetna drives members to their mobile app for extensive self-service options. The more tools health plans give to members, the more empowered they are to manage their coverage.

Overcrowding the Shelves: Why Flooding the Market with Low-Cost Silver Plans May Backfire

The sudden expansion of plans on the ACA Marketplace resulted in the overproduction of silver plans.

With the increase in subsidies for silver plan enrollees, health plans may feel like they should continue to design low-cost plans to capitalize on this market. But this approach can backfire.

Plan filters display the lowest-cost plans first, and consumers can grow frustrated with the over-promotion of similar plans. Many of these low-cost silver plans fail to establish a meaningful difference.

As a response to this issue, CMS plans to advance the standardized plan requirements for carriers during Open Enrollment 2023. All carriers on the ACA will need to offer standardized plan options for every network type, metal level, and service area.

From a design perspective, Wingle notes that standardized plans often feature complex cost-sharing combinations. These plans will have priority placement in shopping portals. The complexity and prevalence of standardized plans calls into question the how effect of a solution this will be.

“You want to be clear on your design stance and who you want to be in the market,” Wingle advises.

Putting Members’ Data to Work: Using Predictive Analytics to Inform Retention Efforts

Using member data to identify the causes of high termination rates allows health plans to make informed decisions about retention and ultimately improve membership rates.

Softheon’s predictive model identifies members at risk for termination due to non-payment immediately upon enrolling. Focusing efforts solely on at-risk individuals could improve retention rates while minimizing spending.

Deutsch introduces the next step in predictive analytics at Softheon – The Immediate Model. Without any payment information, the Model identifies the 22% of the population that contributes to 49% of terminations due to non-payment.

Layering the Immediate Model with the 3-Month Model provides termination predications based where members are on their healthcare journey. What might cause a member to terminate during the first three months of coverage can be completely different from someone enrolled for over a year.

The newfound competitive nature of the ACA Markets means health plans must put their data to work now more than ever. Consumer acquisition costs are rising, and no health plan can afford losing members out the backdoor.

Since their partnership with Softheon, Aetna initiated a payment program that targets those with volatile incomes. Aetna now accepts cash payments at any CVS location.

When implementing this program, Aetna understood that application would be minimal. Most members prefer paying from the comfort of their homes. But member data showed a dire need for a new payment option in specific groups with high termination rates.

Wingle expresses satisfaction with the results of the CVS cash payment program. Those with a true need take advantage of the offering.

To increase retention rates, health plans must review member data for trends that denote pain points.

Going a Step Beyond Traditional Health Plan & Vendor Relationships: Finding a Partner with the Expertise to Guide

Health plans looking to expand into the ACA Marketplace must deal with new and changing requirements that legacy systems struggle with.

Monolithic solutions lack the flexibility needed to integrate with Exchanges and downstream partners. But rip-and-replace solutions can take years to see a ROI or cause more problems than they solve. Aetna is familiar with this struggle and sites it as a reason they exited the Exchange in 2017.

Wingle proposed a new way to look at a health plan’s Marketplace solutions – a collection of interconnected platforms. The combination of internal systems and trusted technology vendors allows health plans to select what works best for them while managing expenses.

Start looking for vendors to address internal pain points and integrate with Exchanges.

“When we decided to get back into [the ACA Marketplace] we boiled the ocean looking for the best solution that we could find,” Wingle noted.

Today’s vendors must go beyond technology requirements. As the ACA Marketplace grows more competitive so do solutions.

“Look for a solution that has the Software as a service (SaaS) down but is also buttoned up on the Business Process Outsource (BPO) piece,” Wingle elaborated.

Health plans should be looking for a true partner that will be able to guide them through the complexities of expanding into a new market.

For more information on how to select the right ACA technology partner, download Softheon’s Shopping, Enrollment, and Billing RFP Guide.