Legislative reforms and consumerization have changed how people shop for and enroll in health plans. Here is the critical infrastructure health insurance organizations need to accelerate data acquisition and optimize the consumer experience.
Before the Affordable Care Act (ACA) became law, health plans relied on an employer-centric model of operation that all but removed captive members from the sales and service equation and traditionally focused on the distribution of risk across the sum of their groups’ captive members.
Now that health insurance is within the reach of millions of more Americans, with subsidies, the market is undergoing tremendous change. To cope with these changes, many insurance companies have attempted to expand into new market segments, such as individual plans on the state and federal exchanges, Medicare Advantage plans, Medicaid, or have added ancillary products to complement their existing offerings. These moves come with significant challenges. For example, cumbersome manual processes to track leads, sales and the success of marketing campaigns, along with siloed databases used to track utilization and service issues that may have worked well handling a limited number of groups are not scalable to handle tens of thousands of individuals effectively. Those legacy tools and processes also will not provide the holistic analytical picture needed to deliver excellent service.