Four common reasons your members switch health plans

January 28, 2021
Josie Rasberry

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Now that we’re at the end of January, health plans are done integrating new members and have shifted their focus to keeping those members happy, engaged, and retained.

Member retention is a key metric to track as it’s far more affordable to retain existing members than to acquire new ones. With that in mind, it’s important to analyze why members left or might leave so you can proactively address those concerns and keep your members happy. In this blog, we’re going to dive into the common concerns members have that lead to them switching health plans. Whether they’re leaving a discount medical plan, a limited benefits plan, or a traditional health insurance (BUCAH) plan, these are some of the most common reasons a member decides to switch:

Cost increase with no value added.

Perhaps the most obvious answer, but an important one. Cost increases for members are a huge driver towards the decision to change health plans; especially if no extra value is added. We get it, when healthcare prices increase, health plans also have to increase their prices. But this is a situation where you can use tactics to keep members, despite cost increase. There are benefits you can add to your members’ health plan without significantly raising costs. This can help justify the member’s price increase, and the added benefits might tempt them to stay. What sort of benefits could you add? The list is endless really. With price transparency in effect, it would be timely and relevant to add tools or services to your plan that help members shop for healthcare and understand the hospital prices they’re now able to see.

Losing established provider relationship.

Good, established patient-provider relationships are crucial to an individual’s health. Let’s say a mother has a pediatrician who perfectly understands the ins and outs of her toddler’s complex healthcare needs, and she and her family are comfortable communicating with this doctor. If your health plan drops her doctor or the doctor drops your health plan, guess what she’s going to do? Find a health plan her doctor accepts. It’s crucial to ensure your members have access to quality providers and to keep those existing relationships intact by keeping providers in your network.

Poor member support.

If your customer service is less than helpful, expect members to end their plan with you as soon as they can. Healthcare is already a stressful and emotional time for people, so when you pile poor member support on top of that it’s no wonder members leave. Health plans likely don’t intend for their member support to be lackluster. You could have limited staff, a busy season, a member who didn’t communicate well, etc.. To reduce churn and create happy members, consider contracting with a third-party company to offer patient advocacy services. This takes some of the workload off your member support team, which allows them to be more helpful in other areas. A third-party patient advocacy service also gives members dedicated support for their healthcare experiences and reflects positively on you.

Life changes.

A lot can happen in a year! A member might have an employment change that requires them to change their health coverage. A couple on your health plan might be pregnant, and now they need very different health coverage. There’s not much you as a health plan can do in these situations, but it’s important to note if you notice the majority of your churn is coming from member life changes. If the percentage is large enough, it might prompt you to consider changing the offerings in your health plan so you can keep members that are leaving.

Sometimes members leave your health plan for reasons you can’t control, and that’s okay. The focus of healthcare is what individuals need to live their healthiest lives. The situations that you can control though, you absolutely should. If members consistently report “poor member support” as a reason they leave, address that issue. If you have to increase member costs, add value so members feel they are getting a fair exchange for what they’re paying. If you listen to your members, address their concerns, and provide them with the offerings they need, you’ll find more of your members are happy, engaged, and most importantly retained.

Download How to Leverage Ambulatory Surgical Centers for Lower Costs and Higher Satisfaction

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Download the Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download the Complete Guide to Retaining Health Plan Members.

Learn the best strategies and tips for retaining your members while keeping costs low.

Download the Complete Guide to Growing Your Health Plan Membership

Learn the best strategies and tips for growing your members while keeping costs low.

Download the Complete Guide to Lowering Member Costs

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download Healthcare Consumerism 101: A Playbook for Health Plans

Learn the best strategies and tips for retaining your members while keeping costs low.

Download Your Guide to the Transparency in Coverage Rule

Discover how the the new rule will affect TPAs and health plans and how you can start your journey to compliance.

Download Your Guide to Unique Benefit Offerings that Don't Break the Bank

Discover how to add value to your health offerings that delight clients and members but don’t cost a fortune.

Download the Complete Sedera Case Study

Discover what health plan members had to say about the value of patient advocacy in our survey.

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