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  • Make It Stick: Engaging Today’s Consumer in a Post-Reform World John Mills - Senior Director, Commercial Products, UPMC Health Plan Lisa Fry - Partner, Subsidium Healthcare Christine Muldoon - Senior Director of Market Strategy, WebMD

    June 3, 2014

  • © WebMD Health Services Group, Inc. All rights reserved. 2

    Our Conversation Today

    Introductions and Overview1

    2 An Outside Perspective: Market Trends Lisa Fry, Subsidium Healthcare

    4 Discussion and Q & A John Mills

    Senior Director, Commercial Products UPMC Health Plan

    3 UPMC Health Plan John Mills, UPMC

    Lisa Fry Partner

    Subsidium Healthcare

  • © WebMD Health Services Group, Inc. All rights reserved. 3

    TOTAL MONTHLY UNIQUE USERS

    64 MILLION 39 MILLION MONTHLY MOBILE UNIQUE

    USERS1

    ACTIVE US PHYSICIANS

    625,000

    440,000 REGISTERED US PHYSICIAN

    MOBILE USERS

    REGISTERED USERS

    7.1 MILLION

    4.7 MILLION ACTIVATED PERSONAL

    HEALTH RECORDS

  • © WebMD Health Services Group, Inc. All rights reserved. 4

    The Six Key Elements You Need to Know for Creating Member Engagement

    New eBook!

    Stay Tuned For Your Copy! All webinar attendees will receive a copy of the eBook.

  • © WebMD Health Services Group, Inc. All rights reserved. 5

    Motivate workers to take charge

    Encourage workers to become better advocates for their health

    Encourage healthy behaviors with financial

    incentives

    Inspire

    Building a healthy workforce is a team

    effort

    Adopt healthy

    behaviors

    Engagement is THE Requirement

  • © WebMD Health Services Group, Inc. All rights reserved. 6

    IT’S ALL ENGAGEMENT

  • An Outside Perspective Lisa Fry - Partner Subsidium Healthcare

  • © WebMD Health Services Group, Inc. All rights reserved. 8

    The stakes are huge….

    The Battle for the Hearts and Minds of Healthcare Consumers

    Nearly $1 of every $5 spent on health care

    $1

  • ….and it attracts a lot of attention from competitors

    The Battle for the Hearts and Minds of Healthcare Consumers

  • © WebMD Health Services Group, Inc. All rights reserved. 10

    Planning Your Consumer Engagement Strategy

    Identify Objectives and Define Success

    Determine Key Capabilities

    Required

    Conduct Gap Analysis

    Outline Key Programs and

    Initiatives

    Measure and Iterate

  • © WebMD Health Services Group, Inc. All rights reserved. 11

    Identify Objectives and Define Success

    Overall Member Loyalty

    Overall Member Loyalty: • Attracting new members • Retaining existing members

    longer to improve ROI

    Health Promotion and Improvement: • How will you define engagement? • Improved health status • Lower costs

    Health plans will define success with a variety of metrics; these are changing with the impact of ACA and exchanges

    Health Promotion

    and Improvement

    Overall Member Loyalty

  • © WebMD Health Services Group, Inc. All rights reserved. 12

    Fundamental Characteristics of Successful Consumer Engagement Programs

    Personalization Convenience

    Time Trust

    Easy-to- Understand Information

    Resources (Money, Time,

    Data)

    Success Factors For Engaging Consumers

  • © WebMD Health Services Group, Inc. All rights reserved. 13

    Key Capabilities Required: Examples

    BRANDBRAND

    CONSUMER EXPERIENCECONSUMER EXPERIENCE

    DATA/ANALYTICS

    Rules Engine

    Segmentation Profiles

    Internal Longitudinal Data

    External Consumer Data

    TOOLS AND PROCESSES

    Rewards, Loyalty Programs

    Mobile Tools

    Consumer Guidance

    Multi-Modal Access and Contacts

  • © WebMD Health Services Group, Inc. All rights reserved. 14

    40%

    17% 1%

    20%

    6%

    17%

    2 in 5 Are Unaware of Their Insurer’s Health Information Site

    Health Info Site Usage

    Over half of eligible health plan members say they use or would use their insurance company’s health information website

    Only 1 in 4 say they don’t use or would not use

    Source: 2014 Blue Research® End User Insights Panel

    Insurance company has site, I’ve used before

    Insurance company has site, I have not used

    Insurance company has website, don’t know if I have

    used

    Insurance company does NOT have site, I

    would not use

    Insurance company does NOT have site, don’t know

    if I would use

    Insurance company does NOT have site, but I would use

  • John Mills Senior Director, Commercial Products UPMC Health Plan

  • Impact of the ACA on Individual and Small Group Markets

    16

    Premium Subsidies

    Cost-Sharing Subsidies

    Medical Loss Ratio Rate Review

    Premium Tax/Other

    Fees Rating Rules

    Essential Health

    Benefits

    Individual Mandate

    • Major upheaval in Individual and Small Group markets • Influx of newly insured individuals • Insurance is moving towards a consumer market

  • • 55.7% are Male • 85% are between ages of 19 and 65 • White residents make up the large majority of uninsured’s • 64% are below 200% of FPL, however 18% are over 300% • 60% of uninsured’s are working, 25% work for companies with less than

    4 employees – Service industry (56.3%) – Retail (16.4%) – Construction (12.2%) – Manufacturing (10.4%)

    • Lower income and education than overall population • Reduced ability to interpret labels and health messages

    Demographic Characteristics of the New Uninsured Consumer

    17

  • • In the past year: – 40% have not seen a doctor – 60% have not seen a doctor for routine care – Less than 10% have stayed overnight in the hospital – 40% have visited the dentist – 10% sought care at an ER because they could not find a doctor

    • Overall – Less likely to take prescription medications on a regular basis – Lower likelihood of seeking preventive care – Greater use of emergency care – Worse overall health status and higher mortality rates

    • Cost is a barrier to Care – 10% skip doses or took smaller amounts to make Rx last longer – 20% had to pay $500 or more out of pocket for services in the past year – 40% report having trouble paying medical bills

    Health Status of the New Uninsured Consumer

    18

  • • Performed extensive persona work and identified key purchasers – In and Out of Medicaid – Blue Collar – Small Business – Affluent

    Persona Work

    19

  • Personas

    20

    FPL 139-250% FPL 251-400% FPL 401%+ FPL Totals

    Annual Income for Ind. $15,856-$28,724 $28,725-$45,959 $45,960+

    • Subsidy Eligible • Shop on Price Primarily • Network is Secondary • Highly Likely to Change

    PCP for 10% Discount in Premium

  • Personas

    21

    FPL 139-250% FPL 251-400% FPL 401%+ FPL Totals

    Annual Income for Ind. $15,856-$28,724 $28,725-$45,959 $45,960+

    • Shop on Marketplace • Tax Credit Eligible • Price Driven • Network is Important • Brand and Access • Wants Insurance that

    Covers his Bills without a lot of Hassle

  • Personas

    22

    FPL 139-250% FPL 251-400% FPL 401%+ FPL Totals

    Annual Income for Ind. $15,856-$28,724 $28,725-$45,959 $45,960+

    • Shop Direct or Via Producer

    • Price is Important • Network is Important • Brand and Access • Higher Income, Can

    Afford Brand Choice • Less Likely to Switch Year

    to Year

  • Personas

    23

    FPL 139-250% FPL 251-400% FPL 401%+ FPL Totals

    Annual Income for Ind. $15,856-$28,724 $28,725-$45,959 $45,960+

    • Shop Direct or Via Producer • Benefits are Most Important • Will Pay More Up Front to

    Not Have to Worry About Costs During the Year

    • Higher Income, Can Afford Brand Choice

    • Less Likely to Switch Year to Year

  • • Take a Healthy Step (TAHS) program is a standalone health and wellness offering that can be adopted with any medical plan  Earn points or dollars  Complete set of activities to accomplish goal  Incentives can be disbursed in a number of ways, at discretion of employer;

    Deductible credits, premium reduction, gift cards, etc..

    • HealthyU is a CDHP product with an integrated health and wellness component  Earn Incentives during the plan year to use during the plan year  Standard Incentive Package  Earn dollars, not points  Earn up to $500/$1000 each plan year  Incentives are used to pay plan covered medical expenses

    Consumer Engagement

    24

  • • Financial incentives can be successful in program participation and behavior change

    • 2011 Harvard University study found that financial incentives helped improve participation in – Smoking cessation programs – Weight loss activities

    • Affordable Care Act permits health plans to charge more for smokers than non-smokers – Rates can be lowe

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