ihealthradio
  • Home
    • About >
      • IN THE NEWS
      • Blog
  • PROGRAM
  • GET FEATURED AS A GUEST
  • MY LIVE TV STREAM
  • Podcasters and Sponsors
  • APP USE PRIVACY POLICY

RSS Feed

Rapid Disenrollments Roots Causes and Remedies

1/15/2020

2 Comments

 
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
Remedies:
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.
4.
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...
Remedies.
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.
Remedies:
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.
III. Competition.
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.
Remedies:
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.
2 Comments
Brandon Flynn link
11/12/2022 12:27:26 am

Prepare try provide assume ask bed throw. Subject possible every up.
Beyond fill special drive. Remember relate summer happen resource hand cell little.

Reply
Indian Girls in Brockton link
10/30/2024 09:27:35 am

Nice shhare

Reply



Leave a Reply.

    Author

    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..

    Archives

    May 2025
    June 2024
    April 2024
    March 2024
    January 2020

    Categories

    All

    RSS Feed

    View my profile on LinkedIn
USPA
AS SEEN ON
Featured on AP NewsFeatured on FOXFeatured on ABCFeatured on NBCFeatured on CBS
AND OVER 240 NEWS SITES
Verified by www.BranderApp.com
​DISCLAIMER: The information provided in our programs including health shows, discussions on fitness, wellness, business, and any other topic we engage with and address, is for informational, sharing resources and entertainment purposes only. It is not intended as a substitute for professional advice, consultation, or guidance. Viewers should always seek the advice of qualified experts or professionals in the respective fields before making any decisions or taking any actions.
While we strive to provide accurate and up-to-date information, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability of the information contained in our health shows or discussions on other topics. Any reliance you place on such information is therefore strictly at your own risk.
We strongly encourage viewers to do their due diligence and independently verify any information presented in our health shows or discussions on other topics before making any decisions or taking any actions. This includes consulting with appropriate experts or professionals who can assess your specific situation and provide personalized advice.
We, THE EMBC NETWORK and its channels, affiliates, officers, directors and guests shall not be held liable for any loss or damage, including but not limited to, indirect or consequential loss or damage, arising from the use of, or reliance on, the information presented in our health shows or discussions on other topics.
By accessing and viewing our programming and shows or participating in discussions on other topics, you acknowledge and agree to the terms of this disclaimer and take full responsibility for any actions you take based on the information provided.
TERMS AND CONDITIONS

​PRIVACY

'Privacy Policy for Mobile App Usage on iOS and Android Platforms'
​​APP USE PRIVACY POLICY

Picture
Picture
Picture

​COPYRIGHT © ihealthradio an EMBC NETWORK production. 2020-2025, All rights reserved

Picture
Picture
Picture
Picture
Picture
Picture
Picture
Picture
Picture
Picture
Picture
Picture
Picture

THANK YOU FOR WATCHING
"Enrich your Mind and Soar Beyond Limits"
"TIME TO EVOLVE"
Hurricane H

Picture
Picture
Picture
Picture
  • Home
    • About >
      • IN THE NEWS
      • Blog
  • PROGRAM
  • GET FEATURED AS A GUEST
  • MY LIVE TV STREAM
  • Podcasters and Sponsors
  • APP USE PRIVACY POLICY