How can we maximize the cost, quality and convenience of healthcare insurance member benefits if providers are unable to quickly identify one benefit plan design from another at the time of service?
The answer: we can’t.
Because of this, patients and providers often lose out on the benefits offered to them by insurance plans; costs and complexities increase, and important care coordination opportunities are missed.
To fix this, providers must be able to identify their patients as members of this or that health network quickly and act on that knowledge when referrals are required. This allows them to easily understand and efficiently promote the privileges associated with membership such as access to the preferred providers.
The advantages of promoting these privileges are not just for the patient, though. Providers benefit as well, and to help illustrate this, we’re going back to the 90s!
Lessons from Outside of Healthcare: Membership has its Privileges
Isn’t it interesting that health insurance is one of the few types of insurance that uses the term “member”? I am not a member of my car, motorcycle, or home insurance, and frankly, I don’t want to be.
When I think about membership I can’t help but recall the long-running American Express ad “Membership has its privileges.” The ad ran from 1987 to 1996, and to this day, when I think about being a “member” of American Express, I not only think of a green credit card with centurion prestige, I think of being special, inner circle, preferred, and preferential.
Consumers’ loyalty to their American Express membership has never had anything to do with points or air-miles. Lots of companies offer such rewards to drive repeat business, but that kind of repetition is not the same thing as loyalty.
Loyalty is the willingness to pay a premium or even turn down a better product in order to continue doing business with the same company. Like any couture label, the American Express centurion was a badge of honor, and a symbol of living the American Dream. “Privilege,” as AmEx knows, isn’t about perks—it’s about instilling a feeling in your loyal customers.
“Loyalty is the willingness to pay a premium, or even turn down a better product, in order to continue doing business with the same company… Health insurance membership has never worked this way.”
Health insurance membership has never worked this way.
Most people hardly have a say in which “club” to join. Our employers or our government decided for us. There is no real selection or exclusivity. A person just happens to be in the right (or wrong) place at the right time.
Feeling special yet?
Healthcare’s Confused Inner Circle
What’s strange is that health insurance does offer a type of inner circle. Many providers and staff just don’t know the benefits of being a member.
Take me for example. As a member of a health insurance payer, I am a part of an exclusive network of providers. Whether you call it a PPO or HMO, only certain providers will see me and/or have established preferred pricing for me. That at least makes me feel a little special.
The problem is that when I show up there really is no indication of my “special membership.”
I’m not expecting a marquee welcoming me or a special access pass to the “member lounge” as I wait to see the doctor (though I wouldn’t turn down an umbrella drink). But members should know about the privileges offered to them.
Things like discounted or even no cost preventive exams/tests per year, access to a discounted provider network (in-network), and other perks do exist for health insurance members. And patients deserve to have their “membership privileges” recognized, but even this is rare. In many cases, not even the provider’s staff know!
“Members should know about the privileges offered to them.”
Sure, member copay and deductibles are usually figured out and boldly stated on the insurance card (which is not nearly as cool as an Amex by the way) but “membership” recognition ends there. It’s rarely recognized at the time of service, leading most patients to believe that membership has NO privileges.
In my own experience, no provider has ever told me of the preventative exams/tests that my membership includes. Worse, when I’ve needed a referral to a specialist, it is as if there is no inner circle of in-network providers. Somehow my membership gets mixed up with countless other memberships. I am either left to identify my member doctors or a non-member doctor is chosen for me. But I am a member! I have this lame ID card to prove it.
Why (and How) Providers Should Promote Member Privileges
So besides improving the patient experience and increasing patient satisfaction, why should providers promote member privileges?
It all boils down to this:
Great companies are built on the backs of the loyal, not the masses.
Of course, with the way healthcare membership has been handled there are two primary problems:
Insurances don’t seem to boast members, they have participants.
Providers no longer have the time to identify all the nuances of all the purportedly exclusive clubs their patients are in.
If providers want to build loyalty in their patients, they must find a way to access and promote the privileges of membership.
Like that proud centurion on the AmEx card, membership in a healthcare plan needs to stand for more than copay and deductible. Providers must participate in delivering on these privileges.
“If providers want to build loyalty in their patients, they must find a way to access and promote the privileges of membership.”
One way to do this that benefits patient and provider is to recognize members and quickly align them to member privileges. Blockit helps providers ensure that they have the valuable reminders and insights needed to do this by empowering providers to recognize a member at time of service and guide them in maximizing their “privileges”. Providers using the platform can guarantee that members stay in-network while also establishing a quick and convenient referral.
The patient doesn’t need to sift through choices or call provider after provider. They know right away who takes their insurance, the providers who are a part of their inner circle. It’s not quite an umbrella drink, but it’s close.
We have a long way to go before the term “membership” actually means what it should mean in healthcare but with a bit of help from digital innovation, we can vastly improve and at the least be able to adequately demonstrate the privileges of membership.
If you’re interested in learning more about how to maximize the benefits of your patients within their care coordination journey, you can contact us today by clicking here or emailing firstname.lastname@example.org.
Dave Gregorio is the Chief Customer Officer at Blockit and the author of the Purpose Quotient®, a nationally recognized framework for Organizational Development. A 30 year healthcare industry professional with a passion for people, Dave is the founder of the Heroes to Healthcare mission and CEO of ImPowerQ Associates LLC.