What are the main types and main reasons that drive health plan organizations’membership dis-enrollment levels?
Understanding trends can help plan executives assess and remedy the issue and put a solid plan together to address and turn the numbers around to acceptable levels.
There are many reasons that affect membership pre and post enrollment:
A. Pre-enrollment Causes:
1. The front line staff.
2. Possible lack of adequate education on plan benefits and services
3. Misrepresentation by plan representatives
Drive by presentation, quick and superficial presentations
4. Not using marketing tools properly
1. Focus on home presentations, Self gens, provider referrals and company generated leads
2. Staff development program, better and thorough training Educational orientation seminars
3. Tighter program policies including a serious and swift disciplinary process.
Use of CMS approved presentation portfolios to assist and guide the presentation at the time of enrollment including questions to help remove objections.
B. Post Enrollment causes.
I. Delivery and access to services:
a. Operational issues, cards not sent on time, too many points of contacts etc...
b. Unable to receive expected services when in need of service.
c. Unable to resolve provider access because of complicated I.V.R systems prompts
Dissatisfaction with Customer service experience (attitude, long wait on hold, run around etc...
1.Ensure that members receive their info on time.
2. Ensure accuracy of demographics from the start and throughout the membership.
3. Simplify I.V.R prompts and make proper adjustments to language needs.
4. Better customer service training, using calibration calls, Ad-hoc training etc…
5. Member outreach and re-education after initial enrollment both on the phone and in person throughout seminars and events including member ambassadors and testimonials.
II. Providers: main reasons:
1. Provider contract rates leading providers to steer membership because of better reimbursement from a competitive plan.
2. Network deficiencies: lack of key providers in service area.
3. Docs having claim payment issues.
4. Provider access to authorization approvals which could be due to how easy is the access to the plan's authorization system or simply to the lack of the response time or the plan'staff's attitude.
More education outreach to providers on plans and why their patients are better off with the plan's products.
Ensure that claims are paid on time.
Offer more lucrative contracts (possible risk)
Contract more key providers in different geographic areas
Simplify the authorization and referral process
Adopt a customer friendly approach with docs
Death: Simply involuntary and part of life especially for MA and MLTC plans.
a. Fierce competitors, poaching members, guerilla marketing tactics.
b. Better retention efforts using outside companies to maintain membership.
c. Massive advertising and branding campaign, including Billboards, print, TV and radio.
d. Larger field teams and Mobile fleets.
e. Larger community relation and events teams.
f. Larger pockets with dedicated budgets.
1. Use similar approach providing it is done compliantly.
2. Foster exclusive deals in exclusive geographic markets.
3. Better or competitive staff compensation and retention to attract and retain talent.
11/12/2022 12:27:26 am
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A seasoned healthcare sales executive and a leader with 26 years of Health Insurance and Managed Care experience, a strategist, innovator and motivator with a vast and deep understanding of Managed Care Organizations and the health insurance industry and its critical nuances and complex design..