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    Top 5 industry challenges of 2016

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    Challenge #4: Reacting to healthcare consumerism

    Consumers are playing a more active role in selecting their health plans because of the growing number of public and private health insurance exchanges. In addition, since many of these plans include higher cost sharing, consumers are more informed about their healthcare costs. All of that translates to more informed, savvy consumers when it comes to healthcare decisions, and that means managed care organizations need to step up their game.

    "Increasingly what we are recognizing is that there has to be much more sophisticated customer segmentation in the healthcare industry," says Connolly. "It's not enough to simply break folks down by men, women, or a couple of different age groups, they really have to think in terms of different markets, they have to think about whether customers want to have in-person experiences versus digital experiences or a combination of the two. When you think about some industries such as retail, which know so much about their customers and how to interact with them and when to engage with them, healthcare really needs to go much more in that direction."

    Here's what you are doing to attract new members and expand market share, according to our survey: 

    • 60% are expanding their customer experience improvement initiatives;

    • 53% are increasing consumer outreach initiatives;

    • 43% are expanding consumer relationship management capabilities;

    • 34% are focusing on improving cost transparency; and

    • 17% are providing more financial counseling.

    Connolly says that while improving the customer experience is critical, she's surprised that more respondents are not focusing on affordability and cost transparency. "Overwhelmingly, consumers tell us that cost is the #1 issue for them right up there with quality of care," she says.

    One way health plans need to adjust to the increasing role consumerism is playing in healthcare is by educating members about their benefit design and making sure information is easy to understand, says Connolly. "Beyond that,  [the challenge is] trying to get consumers to appreciate the need and the value for things such as prevention, healthy living, good management of chronic conditions—a lot of those activities that are going to be beneficial to them down the road."

    This of course, speaks to the ongoing challenge payers and providers face: Getting patients to engage in their own healthcare. To do this, Connolly says a combination of "carrots and sticks" might be effective. "If you think back to big public health campaigns in the past in our country—whether it's smoking, or wearing seatbelts, or drunk driving—all of those efforts involved some financial dimension like taxes or higher prices, they involved incentives, they involved the community and getting almost peer pressured if you will," she says. "I think we're going to need those sorts of comprehensive efforts, especially to get people with chronic conditions much more engaged in their health."

    Next: Challenge #5 - Responding to industry consolidation

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