Managed Care

The rules are changing in healthcare, and 2010 is shaping up to be the year of the consumer. The shift away from a wholesale orientation creates a need for health plans to think and act like retailers — but with a healthcare perspective.

As a result, building loyalty with members has never been more important. How you engage members, develop products, and leverage your brand will all change, especially given the constraints of market reform and the cost pressures plans are under today. Four opportunities to build loyalty stand out:

engaging consumers in critical moments of truth

personalized messaging for distinct segments

real-time experimentation

collection of insights to improve program results

Pharmacy

The pharmacy business is becoming increasingly complex with new plan designs, direct-to-consumer programs, consumer-driven healthcare, value-based design, and client customization. Adding to the complexity are mounting pressures around price, regulation, and the need to demonstrate value, service differentiation, and health outcomes.

To address this, Pharmacy Benefit Managers (PBMs), pharmacies, and health plans are all looking to scale their businesses by employing innovative technology; targeting consumers more effectively; and driving health outcomes and reducing pharmacy trend. Understanding when to reach out to consumers, how to engage them, and what messaging compels them to act requires insight-driven data and coordinated channels of communication.

Population Health

Health plans and population health companies have three primary objectives this year: control costs, improve quality of care, and increase efficiencies. At the same time, healthcare consumers are being asked to take on more personal responsibility for managing their own health.

It's never been more critical to provide members with education and support. This means engaging individuals in lifestyle and disease management programs; informing them of the importance of medication adherence and preventive screenings; and giving them support during critical care transitions. These are just a few of the critical programs that health plans and population health companies should be looking to implement to improve the health of their members and reduce costs.

Medicare

The Medicare landscape is ever changing. Reimbursement is dropping and plans need to do more with less. Acquisition and retention of members remains a key challenge, but now we are seeing an emerging focus on quality and performance.

These dynamics are driving strategies around Medicare star ratings, medical management, and revenue optimization. It's essential that plans maximize every opportunity to capture revenue and achieve differentiation. Plans that strategically leverage objectives will gain a competitive edge this year and beyond.

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Medicaid

The Medicaid population continues to grow due to the expansion in coverage for certain populations under healthcare reform and the poor economy. Yet, chronic disease and healthcare costs are on the rise. Communications innovation is a critical success factor to stretching limited federal and state budget dollars to improve health.

To engage and motivate this often hard-to-reach population, health literacy, cultural beliefs, language preference and other components to personalization should be taken into account. Programs that support the Medicaid lifecycle — including the member welcome process, driving HEDIS outcomes, reducing health disparities, and redetermination education — will be what sets plans apart.