Health insurers can't lose sight of improvements to the consumer experience as they find ways to reduce and manage rising costs, according to a new report from Forrester.
The analysts offered one broad takeaway for payers: "Cut costs, not corners." They noted that the industry is at a key crossroads where it's critical to improve consumer experience and boost trust and consider those challenges as they build strategies around cost.
"Health insurers must improve CX, build consumer trust, and find innovative ways to create more sustainable cost structures and better economics for customers," they wrote. "But the thirst for cost efficiency can’t cloud insurers’ strategic visions to create better health outcomes."
The report highlights several focus areas for payers to consider as they look to strike this balance. For one, they should find ways to reinvent and improve the end-to-end member experience, as the relationship with a member begins before they even enroll in the plan.
Given that the brand cachet for health insurers is low in the current environment, plans should find ways to tell compelling and clear member stories that connect with potential new consumers. Make it clear that members will see lower costs and won't face major barriers to accessing the services they want, according to the report.
A recent Forrester survey found that just 56% of consumers trust their health plan to act in their best interest.
Improving the consumer experience also extends to clients and providers, so insurers should take steps—including leaning on artificial intelligence—to surface more insights to employers and plan sponsors. They should also ease barriers to care, such as prior authorization, that worsen both the patient and provider experiences, the analysts said.
"Providers play a key role in the member experience—patients hear about when a plan is difficult to work with," the analysts wrote.
Insurers should also prioritize investments in cybersecurity, with policies that are reviewed and updated regularly. And, while AI tools show promise, they should be approached with a fair level of skepticism, according to the report.
Also in the tech realm, payers must find ways to better embed digital solutions and programs to ensure they're reaching the intended audience. For example, cancer is the leading cost driver in the employer market, and comprehensive offerings can lead to earlier detection and help patients navigate the care journey.
Payers should also lean into digital tools for the senior population, according to the report. Making new platforms work also requires gathering and tracking data over the long term, the analysts said.
Health plans should also be prepared to push even further into value-based care and experiment more with benefit design as they seek to manage costs without worsening the member experience, according to the report.
One strategy is looking to lower-cost plan customization options that can reach more specific pockets of members. While members don't necessarily want to design their plan from top to bottom, including opt-ins to particular digital programs that meet their unique health needs, or enhancing coverage in areas like pharmacy, can better align with their goals.
That extends to offering additional options to employers, as well, such as individual coverage health reimbursement arrangements, or ICHRAs, that hold particular appeal to smaller firms.
There is significant scrutiny on the pharmacy benefit management space, and insurers should act before regulators rule out any major changes. Payers can follow in the steps of Blue Shield of California, for example, and look to new models in pharmacy benefits that don't rely on a single PBM or company.
For payers that own a PBM, they can take steps to promote transparency and accountability, and look at new contracting approaches in collaboration with clients, they said.
"Last year, we saw strong warnings for health insurers that own a PBM: the loss of major employer contracts, regulatory scrutiny, and a close call on legislation," the Forrester analysts said. "Health insurers must prepare for the day when their PBMs lose the shelter of a parent company."