The key to growing your health plan: a fully managed model

March 25, 2021
Josie Rasberry

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Do any of these sound familiar?

  • “We didn’t meet our membership growth goal due to a lack of support and services.”
  • “Our team spent the majority of time answering member service requests.”
  • “We can focus on either member retention or new member acquisition, we don’t have the resources to do both.”

If you said yes, or fear you may be hearing those statements soon, keep reading!

What’s a fully managed model?

To grow your health plan’s membership without:

  • Neglecting your current members.
  • Increasing costs.
  • Decreasing team efficiency and productivity.

You need a fully managed model for member services. The term “fully managed model” or “managed service” is usually associated with IT services, but in this scenario, we’re talking about a fully managed model for health plans that combines tech-enabled, human-driven solutions to provide your members with a superior healthcare experience.

What would a fully managed model look like for my health plan?

We’ll use our own Smart Healthcare Platform as an example. In this type of fully managed model, you would be giving your members healthcare navigation services and bill negotiation services without your internal team doing any extra work. In fact, it takes a lot of work off your teams. Instead of your team spending all their time answering member requests about where to find a doctor, what hospitals are in their network, or which imaging center is most affordable, they can direct members to two different options for their healthcare navigation needs.

The first option is our easy-to-use app for searching and comparing medical services. The app allows members to quickly find the services they need on their own time and reflects positively on your health plan. The second option is for your members to call a Point Health patient advocate who will find the best care options for that member based on their needs and their plan coverage. Again, this makes your health plan look good, and saves time and money for your organization. These healthcare navigation services allow your team to help current members with other requests and provide better customer service. This of course can lead to more recommendations and membership growth.

Let’s look at the third part of a fully managed model for your health plan. Sometimes members don’t have the option to plan out where they’ll receive medical care, and they end up getting hit with a huge medical bill. As a health plan, you receive a lot of questions about medical bills, especially when they’re expensive. Sending unhappy members to our bill negotiators reduces medical bill totals, eliminates those bill questions from your member request inbox, and turns a frustrated member into a thankful one.

Final thoughts.

Using a fully managed model for your health plan has several benefits that can all contribute to membership growth. Reducing your internal team’s workload by sending member requests to specialists gives you the support to focus on member acquisition. Contracting with a fully managed model that lowers medical bills and guides members to the most affordable care option lowers your overall costs and improves member satisfaction. 

You can put those cost savings towards member acquisition costs, and happy members will be more likely to recommend your health plan. If membership growth is a goal for your health plan, but you still need to control your cost curve, a fully managed model is the perfect solution.

Download the Complete Guide to Retaining Health Plan Members.

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

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