Bridging the Gap: How Payers Can Provide Benefit Plans that More Closely Align with Consumer Expectations to Increase Member Satisfaction

Consumers are increasingly seeking health benefit plans that align with their individual needs and aspirations for a healthier lifestyle. However, health plans are struggling to deliver benefits and health coverage that truly meet the desires of their members, resulting in low member satisfaction scores. This is evident in a recent AIS Poll where 35% of readers indicated that coverage and benefits was the biggest pain point for health insurers’ customers. Additionally, the 2023 JD Power Commercial Health Plan Member survey indicates that overall member satisfaction fell 13 points, driven largely by a decline in customer service and coverage and benefits.

What obstacles are preventing health plans from offering the right products and how do we bridge the gap between consumer expectations and the health coverage and benefits they offer?

Today, many health plans lack a centralized product/plan and benefit data system. This leads to fragmented data, an absence of version control and audit trails, and discrepancies between what is sold and what is installed downstream. All of which frustrate members, overwhelm member service teams, and stifle product innovation.

To bridge the gap, payers need to know what they have, what they’ve sold, and who/what they’re serving. Payers should consider modern product management technology to address the root cause of fragmentation: a Single Source of Truth. Such a system includes:

• Centralizing product/plan and benefit data into one system of record
• Incorporating high levels of automation in workflows
• Adopting a templated design approach to managing the year-over-year portfolio
• Ensuring automated version and audit trails to track changes
• Automating filing
• Seamlessly integrating up- and downstream
• Utilizing the same underlying system for multiple lines of business, and
• Adopting large group and self-funded product design that automates data transfers and enables brokers to customize and personalize benefits at the point of sale

The result? Time for market testing, insights into enhancing your products, and the capabilities to prioritize what is critical to sustainable growth – your products and your members.