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It’s that time of the year: changing seasons, fresh starts, new relationships and a nice sprinkle of chaos. We’re not talking about going back to school – we’re talking open enrollment.
Open enrollment is health plans’ equivalent of Black Friday. Between Nov. 1 and Jan. 15, individuals and families can change their health coverage without requiring a special circumstance.
Many Americans take advantage of this opportunity. For example, more than 21 million people enrolled for a health insurance plan in the ACA Marketplace during open enrollment for the 2024 calendar year. This represents an increase of more than 5 million enrollees compared to the previous open enrollment period.
A recent survey also found nearly 50% of insured Americans are dissatisfied with their current insurance, and 27% of those currently insured are considering dropping their coverage this year or next.
For health plans, this dramatic spike in volume and opportunity to sign new members requires planning and strategy to handle successfully. Just like schools welcoming children back to the classroom, payers need to be prepared – or risk low engagement and lack of retention.
What does it take to welcome new members efficiently and effectively, even during the open enrollment rush? We’ve identified three key tips that can help health plans navigate this season with ease.
1. Nail the basics.
To communicate productively with your members, it’s critical that their information is accurate. Health plans traditionally relied on an unreliable combination of self-reported information and data pulled from various disparate sources to complete new member profiles. Unsurprisingly, this frequently led to breakdowns in communication.
Modern technology, like the FinThrive Contact Confirmer, automates and streamlines this process. With visibility into 95% of the U.S. population – 227 million adults – Contact Confirmer accurately identifies member populations on the first pass 93% of the time. It pulls from up-to-date public and private sources to compile one clean member profile, eliminating redundancy and the manual workload for your admin team.
In addition, Contact Confirmer goes beyond name, address, and phone number to include how your members prefer to be contacted. When you know if someone likes to be texted vs. called or emailed instead of snail-mailed, you can begin building a trusted, value-based relationship from the day that a member signs up for your plan.
2. Don’t pay for claims covered by other insurances.
Secondary and other supplementary insurance coverage is very common in every population. In fact, four out of five Medicare beneficiaries aged 65 and older have some form of supplemental coverage. Without insight into your new members’ additional coverage, you risk overpaying at tremendous loss to your organization.
The solution here: comprehensive insurance discovery. Today’s AI-powered technology can analyze your population at the individual level to identify any other insurance. This eliminates the risk of overpaying, ensuring that payers don’t pay for claims that they don’t cover and dramatically impacting the bottom line.
Automated, powerful insurance discovery increases patient satisfaction, too. When they know about other coverage, care managers can better coordinate member benefits, guiding a member to the right pharmacy, working with their PCP, or making downstream partners aware of the supplementary insurance to streamline the patient experience. Members, as a result, utilize each of their insurance plans in the best way, leading to greater member engagement, satisfaction, and retention.
3. Go beyond the new member welcome.
Sending every single member the same boring packet in the mail no longer cuts it. To provide truly differentiated service to a new member, you must understand and adapt to their life circumstances.
Often referred to as “social determinants of health,” the link between SDOH and healthcare utilization is increasingly evident, with socioeconomic factors accounting for up to 80% of our health outcomes. This substantial influence highlights the need for healthcare organizations, including hospitals, health systems, and especially health plans, to prioritize understanding and addressing SDOH. By doing so, they can effectively reduce costs, enhance operational efficiency and improve member care, reinforcing the essential role of these determinants in shaping healthcare strategies.
Like understanding members’ communication preferences, technology like FinThrive can also collect factors like race, ethnicity and preferred pronouns without relying on member surveys. This information can significantly improve outcomes and the member experience. For instance, members do better with a PCP that they trust. With socioeconomic information, health plans can help members find a doctor who speaks their language and shares the same cultural affiliations, greatly increasing the chance of a trusting and healthy relationship.
Understanding socioeconomic factors is important for the member experience, but also helps health plans prepare for identifying and reporting health inequities. New measurement standards are coming down the pike and will be much firmer than today’s metrics. Partnering with a technology provider who can provide social determinants of health data not only helps you boost the member experience now but sets you up for success in the future.
RELATED: 5 Ways Healthcare Organizations Use SDOH to Make a Difference
Open enrollment is just around the corner. It will always be a busy time for health plans, but with the right preparation and technology, they can turn new recruits into lifelong members.
Download our guide to social determinants of health for more insights into obtaining a 360-degree view of your members.
