How to Enhance Open Enrollment (OE) Program

The open enrollment (OE) period is a busy time of year for payer organizations. A successful open enrollment program takes more time and persistence. The best way to optimize your program is to use a long-term approach with year-round member connection and engagement. There are steps you can take today to enhance the member experience. Think about these steps as a roadmap to examine relevant areas that impact success in achieving OE goals.

How to Enhance Open Enrollment (OE) Program
How to Enhance Open Enrollment (OE) Program

Content Summary

How to Enhance Your Open Enrollment Program
Three Challenges That Impact Open Enrollment
Challenge 1: The customer experience stakes are higher.
Challenge 2: Employers expect better communication.
Challenge 3: Healthcare costs continue to rise.
Three Keys to Open Enrollment Success
1. Improve communication and service.
2. Build trust and loyalty through understanding.
3. Decrease unnecessary costs.
How to Improve Employee Communication
1. Change the perception.
2. Learn to listen.
3. Know your customers.
Best Practices for Acquiring New Members and Engaging Existing Members
Appendix

How to Enhance Your Open Enrollment Program

The open enrollment (OE) period is a busy time of year for payer organizations. Peak season, when individuals and employers can enroll in and make changes to their various benefit plans, lasts from a few weeks to a few months. However, a successful OE program takes more time and persistence. The best way to optimize your program is to use a long-term approach with year-round member connection and engagement.

Health insurers can view open enrollment as an opportunity to attract new members and demonstrate value to existing members. There are steps you can take today to enhance the member experience. Think about these steps as a roadmap to examine relevant areas that impact success in achieving OE goals.

Three Challenges That Impact Open Enrollment

Open enrollment is often confusing and stressful for customers. To avoid this, focus on creating a frictionless, personalized experience and omnichannel communication that will drive satisfaction, build trust and loyalty, and keep administrative costs down.

Challenge 1: The customer experience stakes are higher.

A highly saturated health payer market means greater competition. Top-performing payer organizations are committed to delivering personalized customer experiences to build trust and stand out from their competitors. Members expect convenience and tailored communications delivered on their preferred channels.

According to Salesforce’s ”State of the Connected Customer” report, 84% of customers say the experience a company provides is as important as its products and services. That is up from 80% in 2018. Companies are being challenged to rethink how they engage with increasingly connected, empowered, and discerning customers.

However, healthcare consumers often encounter a fragmented experience with disconnected data and interactions due to siloed systems across sales, service, enrollment/eligibility, claims, and medical management. This can lead to mistrust, dissatisfaction, and disengagement, and ultimately hurt member retention and outcomes. Members want their benefits provider to know their past behaviors and experiences, so they can better address their needs wherever they are in their healthcare journey.

Customers are also looking for simplicity in their open enrollment experience. They want easy-to-understand information on plan options, costs, and benefits, as well as the doctors and hospitals in their network.

Challenge 2: Employers expect better communication.

The “State of the Connected Customer” report found that 69% of business buyers want connected experiences. Technology giants Amazon, Apple, Uber, and Netflix offer convenient connected experiences for customers. This is also what employers want from their interactions with insurance carriers. A digital first, omnichannel, Omni-device communication strategy will help employers prepare for open enrollment and deliver a seamless experience for their employees.

Translating the retail experience to healthcare also requires a new level of personalization. Employers know one size doesn’t fit all in benefits communications and education. “Benefits are personal. At the end of the day, it comes down to each family and each employee in terms of what makes sense for their benefit elections for that year,” said Gina Hanrahan, HR Director at Salesforce. Insurance carriers need to work with employers to meet the unique needs of the business and its employees.

Benefits are personal. At the end of the day, it comes down to each individual family and each individual employee in terms of what makes sense for their benefit elections for that year,” – Gina Hanrahan, HR Director at Salesforce.

Challenge 3: Healthcare costs continue to rise.

Roughly $3.5 trillion is spent each year on healthcare in the United States, with insurers and providers spending as much as $813 billion on administration in 2017. A study published in the Journal of the American Medical Association (JAMA) cites five factors that contribute to overall rising healthcare costs: population growth, population aging, changes in disease prevalence or incidence, increases in the use of healthcare services, and increases in the price and intensity of services.

As healthcare costs rise, so do premiums, deductibles, and copays for enrollees. For example, annual family premiums for employer-sponsored health insurance rose 5%, to more than $20,500 in 2019, according to the 2019 Kaiser Family Foundation Employer Health Benefits survey. During open enrollment, many consumers find it difficult to evaluate premiums, estimate deductibles, and other out-of-pocket costs and choose a plan that will fit their financial and health needs.

Family premiums for employer-sponsored health insurance rose 5% to more than $20,500 in 2019.

Three Keys to Open Enrollment Success

By identifying the problems, health insurers now have a path to improve their open enrollment programs. Today’s most effective open enrollment programs use a combination of tailored and informed interactions, online technology, and user-friendly education. With the right strategies, health insurers can:

1. Improve communication and service.

Community Health Choice in Texas is implementing marketing automation technology that leverages data from marketing, business development, and customer services to retain members and reach new members. Such technology enables personalized journeys based on transactions and behaviors and allows members to receive information when and how they want to receive it.

“Our system now gives us the capabilities to communicate with members at a time that’s right for them, and in the way that they prefer — including via text and instant messaging,” said Rico Urbani, Director of IS System Applications at Community Health Choice. As Community Health Choice further enhances communication and service, it’s deploying solutions such as chatbots and predictive analytics to better meet members’ expectations with timely intervention and meaningful engagement.

2. Build trust and loyalty through understanding.

The digitization of healthcare has created opportunities for insurance providers to better understand their members, anticipate their needs, and deliver timely, personalized communications. This is where cloud-based data tools come in handy — improving accessibility, personalization, convenience, and security that enables consumers to receive necessary health information and share their data with health professionals or family members to make informed real-time decisions. This type of exchange builds long-term member trust.

Consumers are warming up to new technologies in healthcare and becoming more willing to share data. However, more than half of consumers still are concerned about privacy in healthcare as technology continues to evolve quickly. Research shows that 88% of consumers are more loyal to companies they trust, according to the “Connected Healthcare Consumer” report.

Community Health Choice’s use of cloud technology with existing IT systems provides instant access to all relevant member information and identifies the reasons for member engagements. “Armed with a 360-degree view of a person’s health needs, social determinants, and communication preferences, our team members no longer will need to traverse among various systems and screens to find the specific information needed to serve each member,” Urbani said. “Since bringing on Salesforce less than a year ago, 68.5% of our team members no longer require the use of multiple systems and sources” Urbani adds, “by Q1 2020 we expect to be close to 99%.”

Since bringing on Salesforce less than a year ago, 68.5% of our team members no longer require the use of multiple systems and sources” – Rico Urbani, Director of IS System Applications at Community Health Choice.

3. Decrease unnecessary costs.

Changes in how health insurance companies engage members and employers for open enrollment can benefit their bottom line. Streamlining and automating member communications — from printed materials to call centers — will decrease the processing time and yield significant cost savings.

The most frequent call that Community Health Choice receives — from both members and providers — pertains to what coverage a person is entitled to if they’re on benefits. “Because we now have the tools to help our agents quickly connect the dots, they can immediately understand a member’s situation when receiving a call and provide answers for them much faster and more efficiently,” said Urbani. It’s shorter handle time and better customer service quality, for a lower cost per call.

The savings opportunities for insurers extend beyond operations to guiding members toward more cost-effective care options. With customized and timely health information, insurance carriers can inform members and employers about options for receiving care in the right setting at the right time. At Community Health Choice, teams can seamlessly connect with providers throughout members’ healthcare journeys. According to Urbani, “This ensures patients receive appropriate care regardless of their circumstances.”

Because we now have the tools to help our agents quickly connect the dots, they can immediately understand a member’s situation when receiving a call and provide answers for them much faster and more efficiently.” – Rico Urbani, Director of IS System Applications at Community Health Choice.

How to Improve Employee Communication

Open enrollment can be a stressful time for both employers and employees. It’s a labor-intensive process for employers and filled with complicated decisions for employees that can have costly consequences. There are several ways health insurance companies can help make the open enrollment process a positive experience.

1. Change the perception.

Employees are not always excited about signing up for coverage. A recent Aflac study found U.S. workers are stressed about understanding what benefits they need and enrolling in health insurance. “Employees look at carriers as a roadblock,” said Gina Hanrahan, HR Director at Salesforce. “We as benefits professionals see carriers looking to support employees.”

How do insurance companies bridge that gap, so that employees depend on their insurance carriers as a resource for good health and not a barrier? Start by being proactive with communications, according to Hanrahan. It’s not only reaching out when saying no or paying medical bills. Companies can reach out with ways to support the employee and their family.

Insurance carriers can use their demographics and claims data to anticipate employees’ health needs before they arise and determine how to address those needs. For example, how many employees are tobacco users, and have they been offered access to wellness programs to help them with smoking cessation?

From the human resources perspective, benefits professionals are looking to insurance carriers as committed partners. “We want payers to be more involved than they are,” said Hanrahan. Small tweaks to benefit plans here and there can add up to a major lift for employers to modify all the open enrollment tools and resources on their own.

2. Learn to listen.

“Listen to employers — what are their objectives?” said Hanrahan. This is key to improving the way payer organizations communicate with employers, helping them to better understand what employers need to foster a healthier, more productive workforce. Poor worker health costs employers $530 billion per year.

“From the sponsor perspective, we’re dealing with 20, 30, 40 different vendors, all coming to us with different messages,” said Hanrahan. Not surprisingly, this can be overwhelming for HR staff and employees alike. For Hanrahan, it’s essential for insurance carriers to know the unique needs of the employer and use that knowledge to create design changes and supporting resources, taking into account employees’ health status, preferred communication channels, and engagement incentives. “What are the employer’s objectives — how can they tailor their tools and resources to help and support that overarching message?” Hanrahan said.

This is key to improving the way payer organizations communicate with employers, helping them to better understand what employers need to foster a healthier, more productive workforce. Poor worker health costs employers $530 billion per year

3. Know your customers.

Employees are more likely to become engaged in the open enrollment process if they understand the value of their benefits. Personalizing the message goes a long way to making employers and employees see the value of their insurance carriers and the value of their health. For instance, if an employer is rolling out a new supplemental life insurance program, sending out blanket information to all employees isn’t going to engage the target audiences and get the right benefits to the right people. However, recommending relevant supplemental program options demonstrates you know that customers and can offer products and services that meet their needs.

This is where insurance carriers can ensure the appropriate members are receiving the information to make the right decisions in their benefit elections. As Hanrahan noted, payer organizations can use their data to help determine messaging that would truly resonate with each audience, from Gen Z workers to millennials to those who may soon opt into Medicare.

Payer organizations can use their data to help determine messaging that would truly resonate with each audience, from Gen Z workers to millennials to those who may soon opt into Medicare.

Best Practices for Acquiring New Members and Engaging Existing Members

Attracting and retaining membership is key to the success of payer organizations. Having a smoother open enrollment process can help insurance companies drive the active engagement and growth needed.

Engaging new and existing membership is an ongoing conversation, and it needs to be easy for customers to be part of that conversation. With that in mind, Minnesota-based insurance company UnitedHealthcare created an online database of open enrollment resources that consumers can access at any time from anywhere. Members and nonmembers alike can learn about common health insurance terms or ways to save money on prescription medications.

Harvard Pilgrim Health Care, a not-for-profit health services company in New England, is simplifying the onboarding process for new members with a digital welcome program called SmartStart that seamlessly guides members to the services they need, even before their coverage takes effect. “We understand that signing up or switching health plans can be a pain point for many members and employers,” Beth Roberts, Senior Vice President, Commercial Business at Harvard Pilgrim, said in an announcement. “With SmartStart, we are helping ease this transition with integrated, data-driven supports that begin before the effective date to guarantee uninterrupted care.”

As members look for a modernized and personalized experience, here are some tips to enroll, engage, and motivate customers.

Leverage digital outreach

  • Retargeting
  • Paid digital ad campaigns
  • Display advertising

Optimize email and newsletters

  • Targeting and segmentation
  • Multimedia and visuals
  • The educational content on featured programs

Make interactions easy

  • Digital enrollment
  • Virtual meetings
  • 24/7 access to materials

Keep it going

  • Evergreen content relevant throughout the year
  • Periodic updates to remind members you’re there for them
  • Let members know they made the right decision

We know that individuals and families need to have the right amount of coverage to meet their health and financial needs. That’s what makes the open enrollment process so important. When members and employees don’t understand their cost and benefit choices, they can end up overinsured or underinsured — a losing situation for members, employers, and payer organizations.

The right digital tools and strategies will create an open enrollment program that will inspire action and ensure your members and employers get the coverage they need. Doing so means insurance companies can focus on what they do best: providing access to programs for better health and lower costs for members.

Appendix

The Checklist: How Do You Know if You’re Ready for Open Enrollment Season?

There are several things to keep in mind when designing and administering plans for the coming plan year.

Readiness Assessment Checklist for Open Enrollment

  • Policy Updates
  • Compliance
  • Data and Technology
  • Training
  • Outreach

Policy updates. These include changes to benefits, networks, and rates based on what is approved by state and federal regulators. Members should receive a notice describing any changes to their policy and the new monthly premium before open enrollment begins.

Compliance. Know the legal changes affecting the design and administration of plans for the upcoming benefit year and include these required changes — affordability thresholds, out-of-pocket maximum limits, health savings account limits, and mental health/substance use disorder parity, as well as any changes outlined in the Centers for Medicare & Medicaid Services’ (CMS) call letter and final rule for Medicare Advantage.

Data and technology. Test how payer organizations’ IT systems connect with the exchange’s IT system, for everything from enrollment data to revenue reconciliation. Functioning, consumer-friendly data, and technology tools are effective for facilitating enrollment and renewal.

Training. Conduct training with enrollment staff for processing applications, terminations, and changes. Make sure the sales team and customer service representatives understand benefit changes and their impact. Develop scripts so they are prepared to answer any questions.

Outreach. Develop and distribute outreach materials to raise awareness of coverage options, the benefits of having coverage, and how to apply. Ensure the accuracy of member materials, including phone numbers, page numbers, descriptions, and dates.

Source: Salesforce