(This article has been updated with a correction.)
Health insurers are trying to figure out what makes consumers tick as the market increasingly becomes a direct-to-consumer business.
But new surveys suggest that some of the previous ideas have been misguided.
The backlash against restrictive health maintenance organizations in the 1990s gave rise to the idea that what consumers want is choice, said Jean-Pierre Stephan, a managing director at Accenture. But many people would be willing to accept a narrower, coordinated-care network as long as they still have control over their medical information, a survey from the consulting firm found.
Accenture unveiled the survey results, conducted with America's Health Insurance Plans, on Friday during AHIP's annual meeting in Nashville.
“We found that patients actually prefer these coordinated-care networks,” Stephan said. “Consumers don't want unlimited choice. What they want is a few good choices.”
Consumers are more loyal to their preferred airline or hotel chain than their doctors, he added. Only 26% of the 1,980 adults surveyed said they would definitely leave a network if their doctor stopped participating in it. Ninety-four percent said access to their medical records was the single most important piece of information-sharing.
They also valued things such as the ability to talk to their physician during and after business hours and tools such as online scheduling.
“The assumption is that consumers are going to stay in these networks if their doctors are in the network,” Stephan said. “(But) it's not about the doctor, it's about the network experience.”
Anthem has become more consumer-focused since CEO Joseph Swedish, former CEO of Trinity Health, joined the company, Meg Rush, vice president of digital solutions, said during an AHIP panel on the consumer experience. In one pilot, for example, Anthem focused on its call centers in the Northeast, looking at factors such as how reps are hired as well as how they interact with consumers.
“(Consumers) want competence, they want clarity and they want ease,” Rush said.
In addition to getting into the heads of consumers, health plans want to know how to get physicians to help them hold down costs and transition to value-based care as they build their networks.
But some are deciding they are not going to waste resources trying to reach doctors who simply refuse to change. “If you're not willing to engage with us, you may find yourself out of the network,” said Dr. Amy Fahrenkopf, vice president of medical transformation for Highmark.
The shift comes as health plans are learning more about their exchange populations. The actuarial risk in the individual market is about 10% to 30% higher than in the small group market, according to findings from an analysis conducted by Wakely Consulting, an actuarial consulting firm. What was surprising was the magnitude of the difference, said Ross Winkelman, director and senior consulting actuary. “(It is a) big curveball to the health plans, big curveball to the actuaries trying to price these products.”
New members tended to be higher risk than existing members, and transitional members were healthier than non-transitional ones.
One health plan found that its exchange enrollees had 64% more emergency room visits and 39% more admissions than non-exchange members, said Kevin Ruane, director of consulting services at Truven Health Analytics. And people who bought a platinum plan had 216% more admissions and 125% more emergency room visits than those in a non-exchange plan.
(This article has been corrected to indicate that people who bought a platinum plan had 216% more admissions and 125% more emergency room visits than those in a non-exchange plan.)