Consumer Engagement and Health Benefit Exchanges
With the increased demand for individual health coverage, the proposed development of Health Benefit Exchanges and the unknowns of Federal Health Reform, one significant and common market driver is the need to focus on the member. The analysis and evaluation of new business opportunities, the modeling of expecting population shifts and the recognition of the impact of new regulations and deadlines are all putting pressure on health plans to be proactive.
OptumInsight has proven methodologies, customizable tools and experienced professionals who know the health care market inside and out including processes, membership, systems and politics. From member movement scenario modeling and surplus management programs to Health Benefit Exchange engagement strategies including Customized Member Communications, we offer the support health plans need to stay viable and to be successful as the health care market continues its rapid evolution.
Member Movement Modeling
In response to the possible 32 million Americans who will enter the health insurance risk pool, health plans need to prepare to accommodate the impending new member influx and shifts in the types of coverage these individuals need. The OptumInsight member movement modeling tool utilizes micro-simulation and econometric price elasticity sensitivities to project the size of newly covered populations, their likely sources of insurance, shifts in the coverage of individuals who have existing coverage, and the cost impact of these options to key stakeholder groups.
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Health Benefit Exchanges
The next 24 months will feel like a sprint for health plans as they develop products and market strategies, gain state filing approvals and exchange qualification of health plans organize to be operationally ready to launch products on Health Benefit Exchanges (HBE) in the fall of 2013. OptumInsight offers end-end solutions for commercial payers, ACOs, CO-OPs and traditional Medicaid payers for evaluating opportunities, developing strategic plans and identifying requirements to compete on the exchange in 2014.
Surplus Management
Health plans must prepare for financial and operational changes to accommodate the shifts in members and the types of coverage that will be in demand. These fluctuations will create demands on surplus that will affect the health issuer’s capital position. OptumInsight’s Surplus Management Program supplies health plans with data-driven insights that can be used to formulate strategy and tactics to mitigate potential risks and optimize growth.
Customized Member Communications
The need to build and maintain direct relationships with members is fast becoming a top priority for health plans. Essential throughout the member-health plan relationship, communications are often required and/or regulated; are highly variable based on regulation, product data and member-specifics; can be a vehicle for member satisfaction and retention. Tailoring those messages allows for members to feel like unique individuals and reinforces a deeper engagement level between the plan and their customers.
