5 Ways to Position your Qualified Health Plan (QHP) for Success in 2016


The 2016 Qualified Health Plan (QHP) open enrollment period is fast approaching – with a shopping window from November 1, 2015 through January 31, 2016.

What will your outreach strategy be?

How will you handle changing market dynamics such as rate increases, new entrants, and the QRS reporting requirements?

At Eliza we've been reflecting on the unique needs of the QHP market and how we can help. Below are 5 QHP population insights to consider:

  1. Use terms that consumers will understand. A good portion QHP members are new to health insurance, and are unfamiliar with concepts and terms such as "co-payment," "co-insurance," and "deductible." Eliza's Welcome and Onboarding Solution introduces members to the plan and explains the "health plan basics" in a way that won't confuse or overwhelm them.
  1. Be prepared to compete. There is more transparency in the QHP market than in most insurance markets. The majority of signups are through online portals, so the shopping experience allows users to compare plans based on benefits, price, network and starting next year, quality ratings. Eliza's QHP solutions were designed to build brand loyalty and member satisfaction while increasing health outcomes, thereby improving Star ratings and member retention.
  2. Know your customer. The QHP market didn’t open up until 2014, and health plans have had very little insight into the health status and risk profile of the population. They're only now starting to get a better understanding of what the population is like from a clinical perspective, although there are always changes and new enrollees to account for, which is why Health Risk Assessments (HRAs) are so important. Eliza’s Welcome and Onboarding outreach includes a customizable HRA that provides insights into individual medical, behavioral and socioeconomic needs, allowing plans to connect them with resources right away.
  3. Prepare for overdue premium payments. Many QHP members have limited experience paying monthly premium payments, resulting in 6% - 10% attrition each month due to nonpayment of premiums. Additionally, individuals and families collecting premium subsidies are eligible for a 90-day grace period before they are dis-enrolled for nonpayment of premium. QHP carriers must continue to pay claims during the first 30-days of the grace period -- and over 85% of QHP enrollees collect premium subsidies, making the financial risk for carriers a real one. One way to reduce attrition and financial risk from nonpayment of premium, is through Eliza’s Payment Reminder solution. This multi-channel, proactive outreach reminds members that their payment is due along with information and instructions about ways to make payments. In past uses of Eliza’s Payment Reminder solution, Eliza delivered a 70% increase in performance compared to traditional direct mail outreach, and delivered in excess of a 20:1 return on investment.
  4. Stress the importance of preventive care. Many QHP enrollees haven't had access to primary care before, so it's imperative to stress the importance of preventive care, the role of a PCP and appropriate use of health care resources. Many of Eliza's outreaches focus on these things including our Welcome and Onboarding, adult preventive and child wellness, and ER Utilization

By now you're probably sensing a theme. The QHP population is new to health insurance, which poses all sorts of challenges. In addition, this is a tech-savvy group of people with access to the internet, smart phones, and other communications devices, making them perfect targets for smart multi-channel approaches. We took all of this into consideration when we developed Eliza for QHPs, a multi-channel solution suite designed to influence QHP member behaviors that impact costs, utilization and satisfaction. The 16 solutions work together to create a holistic communication approach, but also provides clients the flexibility to choose any combination of solutions based on their challenges and objectives.

For more information about the Eliza for QHP solution suite, contact us at eliza@hms.com or 1.844.343.1441.



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