Curing the Knowledge Gap: The key to high quality, affordable healthcare

The passage of the Affordable Care Act placed control for selecting health insurance plans squarely in the hands of the consumer. Through health exchanges, consumers were able to shop directly for plans, instead of relying on insurance agents. To help consumers make “apples to apples” comparisons, the ACA mandated that health insurance companies provide a Summary of Benefits and Coverage describing premiums, copays, and covered services. The goal was to empower consumers to make informed decisions about their healthcare.

While more Americans than ever are shopping for health plans, their awareness of key health insurance concepts lags behind demand. In a survey conducted by UHC, only 7% of respondents could successfully define four basic health insurance concepts: plan premium, deductible, co-insurance, and out-of-pocket maximums.[i]

The gap in consumer awareness extends to comparison shopping for healthcare providers. In McKinsey and Company’s Consumer Health Information survey, only 22% of the participants said that they always ask about cost before going to a doctor or other healthcare provider.

The costs of this knowledge gap are high for both consumers and healthcare payers. Prices for equivalent medical services can differ by as much as 300 to 500 percent within the same region and health plan network and that translates to higher premiums and fewer options when it comes to finding high quality, affordable health insurance.

Clearly health payers and providers must find more effective ways to educate consumers about plan benefits and treatment options. Although the healthcare industry has been slower to adopt digital solutions than other verticals like financial services, early data suggests that digital transformation is a winning strategy.

According to McKinsey and Company, 70 percent of patients around the world (aged 18–65) of survey respondents around the globe expressed interest in in digitally monitoring their health data.[ii] UHC customers are also turning to digital technology to meet their healthcare needs. In 2015, 32% of plan members used the internet or mobile apps to comparison shop for healthcare services.  Adoption of digital technology represents a 230% increase since 2012, when just 14% reported using the internet or mobile apps to comparison shop for health care services.[iii]

Not surprisingly, the digital trend is led by millennials, who are more likely than other demographics to use technology to manage their healthcare needs. Millennials are also far more likely to participate in social media and online wellness groups. Participants of all ages cited scheduling appointments and communicating with doctors as top two reasons for using technology.[iv]

Digital transformation provides a powerful antidote to lack of consumer awareness, but it’s not a cure-all. When it comes to accessing help for a specific issue or question, 78% of UHC survey respondents indicated that they prefer live support. Email and online chat were the next most popular options at 7 percent each.

To meet the needs of consumers, healthcare payers must adopt a hybrid approach to customer service that includes both digital and live support. This blended approach requires an adaptive communication solution that can seamlessly transition between automated services and personalized attention from customer service representatives. Payers need a solution that supports call center integration and offers real-time editing and proofing capabilities so that users can generate multiple plan versions on demand. Other features to look for include the ability to pull data from multiple sources and formats so that users can leverage analytics and customize plan offerings to meet the needs of individual consumers. Most importantly, the solution must be optimized for mobile presentment and multi-channel delivery.

By incorporating automated digital services and personalized support, payers can empower consumers to make evidence-based decisions about their health while cutting the high costs so often associated with medical care. The resulting benefits are something that everyone, from payers to consumers, can appreciate.

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