Three ways a Smart Healthcare Platform can improve your health plan’s bottom line

May 6, 2021
Josie Rasberry

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Keeping organizational costs low is a top priority for health plans. To reach that goal, you have to ensure everything you do has a strong ROI. And not just financially. Ideally, your services and tools also contribute to member satisfaction and member growth. Finding a solution where these two goals meet (improving your bottom line and keeping members happy) is a necessity for your health plan’s success. The Smart Healthcare Platform might be that solution for your health plan. Keep reading to discover three ways this platform can improve your bottom line.

Lower claim amounts.

Let’s go ahead and address one of the biggest components of your health plan: claims. Fully or partially helping members pay for their medical care is why your plan exists. Expensive claims hurt your cost curve and add extra financial burden to members with high out-of-pocket costs, leading to dissatisfaction. But two components of a Smart Healthcare Platform can reduce the cost of claims: healthcare navigation and bill negotiation.

For non-emergency medical situations, human healthcare navigators listen to your members’ needs and find the best option for them that provides great care at a low price. This keeps members from going to out-of-network providers who then send you huge bills. If you don’t operate on an in-network/out-of-network system, healthcare navigation still points members to the most affordable option. One study found that healthcare navigation recommendations created an average cost savings of 61% over a four-year period.

Another part of the Smart Healthcare Platform that can lower claim amounts is bill negotiation. This service steps in after you’ve already processed an expensive claim, and now your member has a high out-of-pocket bill. Patient advocates trained in bill negotiation tactics will work with members and facilities to lower that medical bill as much as possible. And at a minimum, your members will appreciate the hands-on support while they are going through a stressful situation.

Reduce new member acquisition costs.

Did you know it can cost five times more to attract a new member than retaining an existing member? Plus, improving retention by just five percent can increase profits by more than 25 percent. By improving member retention, you cut down on acquisition costs. A Smart Healthcare Platform provides two very important features that lead to higher member satisfaction and better retention:

  • Digital self-service tool.
  • Patient advocacy.

The platform includes an app that allows your members to easily shop and compare thousands of healthcare services. This kind of digital self-service tool is becoming increasingly important to members. One study even found that health plans with digital capabilities outperformed others in overall satisfaction and retention by nearly five percent. Patient advocacy services of any kind also contribute to member satisfaction. Another report showed an average NPS growth of 16.5% for health plans that offer a patient advocacy service. These increases in retention could decrease costs by reducing your need for new member acquisitions.

Fewer service requests for your team.

Outsourcing certain member needs shifts workloads off your internal teams, which can help you save money. For example, the Point Health app is a front door to healthcare that gives members the power to make informed healthcare decisions without submitting any help requests to your team. For more complex healthcare situations, patient advocates step in to navigate your members to the right care. This frees up your member support team to focus on other requests, increase response time and improve member satisfaction.

What this means for you.

Even if Point Health’s Smart Healthcare Platform isn’t the right choice for your health plan, there’s no denying that patient advocacy and digital health capabilities:

  • Reduce medical claims costs.
  • Reduce members’ out-of-pocket costs.
  • Reduce new member acquisition costs.
  • Improve efficiency in your member support teams.

All these benefits lead to cost savings and can improve your health plan’s bottom line.

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 Growing Your Health Plan Membership

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

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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