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When It Comes to Getting Consumers Insured, We’re Missing a Step


“What we’ve got here is a failure to communicate.” That oft-repeated phrase, made famous in the movie Cool Hand Luke seems particularly appropriate given the confusion that still abounds as healthcare consumers consider their options in the third open enrollment period of the health insurance exchanges. As we’ve noted here previously, a scant 22 percent of the uninsured view the exchanges favorably. News about the possibility of significant rate hikes for 2016 plans will likely dismay consumers further. Hospitals and insurers alike need to do a better job of developing patient engagement strategies to overcome the confusion and empower consumers to choose the right type of healthcare coverage—whether on a federal or state exchange or through an employer or the individual market.

Why Are Healthcare Consumers Still Confused Three Years Later?

This year, according to Kaiser Health News, the federal government will spend more than $100 million on marketing and enrollment in hopes of reaching approximately one million uninsured consumers in key markets—Newark, NJ, Houston and Dallas, TX, Chicago, IL and Miami, FL.  While helping healthcare consumers navigate the often confusing enrollment process is important, that’s not the only reason that consumers are failing to join insurance rolls.

KHN reports that one reason behind a lack of consumer interest is many people do not understand what the Affordable Care Act offers. In addition to being unsure of benefits related to subsidy eligibility for insurance premiums, many are unaware of the cost-sharing support designed to help low-income families meet the deductibles and other out-of-pocket expenses they incur. Moreover, for families that are living from paycheck to paycheck, the thought of an additional monthly expense often leads to inaction. While the threat of tax penalties is looming, many people are unaware of this potential cost or do a quick calculation and decide that a penalty in the future is less threatening than the past-due electric bill, so they opt not to purchase insurance.

Even consumers who were excited to finally have insurance are finding the plans offered on the exchanges frustrating to use. Many opted for low premium, high deductible options, only to discover later that the narrow provider networks offered by these plans make it difficult to access the healthcare services they need.

Last year, when KHN surveyed outreach programs that help the uninsured, under-insured and newly insured, more than 80 percent reported that, “… consumers seeking their assistance didn’t understand or were confused by the Affordable Care Act.” Those programs also reported that almost 75 percent of the consumers they spoke with did not understand “basic insurance concepts, including deductibles or provider networks.” Is it any wonder they’re feeling disenchanted?

Education is a Key to Better Decisions… But It Isn’t Enough

This isn’t news to insurance companies. Speaking on behalf of the trade organization America’s Health Insurance Plans, Susan Pisano told Modern Healthcare last year, “We as a community have been very focused on health literacy as an endeavor within the industry. But it’s been amped up.” AHIP members receive new-member kits, one-on-one calls, webinars, and reminders about preventative care coverage.

A recent Health Affairs blog reported on a series of interviews conducted with facilitator organizations that helped with enrollments among underserved populations including African Americans, Asian and Pacific Islanders and Hispanics in the first enrollment period.

During the interviews, they discovered that many newly insured consumers did not understand how to use health insurance for routine care and prevention. One organization found that many of the newly insured thought that their policies only covered emergency room visits and hospital stays. Many also didn’t understand that there were other costs—beyond the premium—that they might incur, depending on the type of policy.

We already know from c2b solutions’ studies that the uninsured fall into five different psychographic segments. Each psychographic segment has its own approach to health and wellness and priorities with regard to health insurance.  In order to educate and activate these consumers, you need to deliver education materials with the right segment-specific messaging, through the right channels based on their unique attitudes towards healthcare. The provision of education alone is not enough; if it was, more than half of physicians – arguably the most health-educated people in the world, wouldn’t be overweight or obese

Giving consumers the tools they need to understand, choose and use health insurance effectively requires a multi-pronged approach that takes into account not just their current health literacy level, but also unique behavioral and decision-making differences between consumers.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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