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What Health Plans Aren’t Getting About Member Engagement

As a healthcare analyst, a health plan member, and occasionally a patient, I wear multiple hats. So part out of professional curiosity and part for personal interest, I probed around a number of health plans and their benefits administrators in the industry to see for myself what their member experience was like, beyond their marketing page. What I uncovered fell short of what I was hoping to find.

Customer-friendly features that would help with member engagement were just inadequate, if not outright poor. Features such as extended contact hours, consolidated dashboards, easy-to-understand explanations of benefits (EOBs), claims that were in adjudication, and clear explanations of patient responsibility were largely absent. A link to the provider site or the ability to pay my provider bills at my plan’s site as well as live chats, which our industry journals and headline speakers celebrate as patient engagement initiatives, were also missing from that probing exercise. Reality did not match the self-congratulatory talk.

So just what did I hear that spurred me to get blogging? I’m glad you asked.

Don’t say “1-800.” I really don’t want to call a 1-800 number between 8:00 a.m. and 5:00 p.m. EST—I am working at that time. I also don’t want to press 4, then 3, then 2 to reach either a voicemail that tells me to call back—you guessed it—between 8:00 a.m. and 5:00 p.m. EST Monday through Friday or an interactive voice response that doesn’t understand my request. I don’t want to hold for a customer service representative or hear a recorded voice tell me they are experiencing higher than expected call volume (which they should have hired additional staff for). Give me an easy way to find answers on my own, or better yet, a live person via chat at 10:30 p.m. or 2:00 a.m. or on a Sunday afternoon, when I am not working. I’d happily engage then.  

Don’t make me log in four times. The healthcare provider, the lab, the billing company, the insurance plan or pharmacy benefits administrator, and the health savings accounts (HSA) all sit in different organizations. Once I get a bill from, say, a hospital visit, it is often followed up with several offspring bills from the physician’s office, then the lab, then the imaging center, and perhaps the cast room. Oh and I need that prescription because I want to be a medically adherent patient.

I’ll have to compare those multiple bills with the EOBs to see who paid what to whom in hopes of figuring out what I owe. Wish me luck navigating a labyrinth of service dates, line items billed in code, charges waived, charges paid for, and charges possibly due for payment by the patient. Next stop, the HSA—is there enough in that account to pay the bills? Good luck remembering the password to each of those sites too. Is your head swimming yet? Mine is, and I do this as part of my living. That member engagement door just closed.

Don’t pretend to have a smart app; you don’t. I am deleting apps more often than I am adding them these days as I Marie Kondo my life. I’m not going to clog up my phone with yet another app that I may use a handful of times a year (not counting password resets!) and that does not spark much joy.

Don’t claim you are end-to-end; you aren’t. Unless you can spare me from logging in to multiple sites and resetting my password multiple times and digging around for that checkbook and a stamp at 10:00 p.m. on a Thursday night, don’t claim that you are end-to-end anything. What would help is a one-stop shop that pulls multiple healthcare provider billing pages, my insurance claims page, and my HSA balances page in one site, with one password. I understand this is not easy because of HIPAA and patient privacy, but if you’re going to claim to be patient-friendly, those disparate accounts should be linked for my benefit. As a customer I would happily provide some form of authorization to make that happen. Nobody has asked me yet, though.

Stop with the checks. Figure out how to make a deposit into my HSA or checking account. Reduce paper, go green, etc. These are not new concepts nor are they hard to implement. The health premium payments are already recurring via automated payments, so take a page from that playbook. PayPal, Venmo, Zelle, Apple Pay, and direct deposit options all have lower administrative and processing costs compared to checks, so that should be good incentive right there. I pay for babysitting, cleaning services, and food delivery with Venmo. You as a large institution should be able to manage something similarly straightforward and quick. Maybe get the bank custodian on board so I can reimburse myself quickly using real-time payments if I pay with funds outside my HSA. Anything else is honestly not that patient friendly or engaging.

Don’t say “customer friendly. I am busy trying to be an engaged, productive employee in a competitive marketplace that requires an evolving skill set, balance work and life, and plan for retirement and maximize my HSA contributions, all while reducing stress and keeping some health and wellness in the picture. So I really don’t want to stay on hold or call at a time that is convenient for the payer—not me—nor do I want to remember complicated passwords that I promptly forget because I’ve reset them so many times.

If health plans want to applaud themselves, they must strive to practice what they preach during those inspirational keynotes. Offer convenient contact hours and live chat, and provide simple at-a-glance dashboards and EOB documents as well as a one-stop, one-password portal that I can get into anytime, anywhere. Otherwise, let’s be honest and admit we still have a way to go before declaring victory on member engagement.