Open Enrollment All Year: Plan for Value—Not Just Volume

Updated on December 4, 2023

Open enrollment is a critical moment in the member journey, at the front door of the personalized, value-based health experience that members demand. But it’s also increasingly recognized that the critical season is no longer just from October to February. Research shows the need for first impression excellence to be sustained all year long, and the years after. According to an American Journal of Medical Care study, among new Medicare Advantage (MA) enrollees, 15.6% had changed insurance within one year after enrollment in MA and 49.2% had changed insurance by five years. That means the pressure is on beyond the first few months or year one alone.

According to research, the cost of recruiting new members ranges from $200 for commercial members to $800 for MA members. Open enrollment shouldn’t be misunderstood or miscategorized as a time to “survive”—when it may perhaps be better understood as an opportunity to set the tone for sustainable excellence—over many years. This means onboarding members with a warm open enrollment including empathy and providing moments of truth experiences that make an impact. 

There are three critical areas of enrollment that can set your organization up for successful member retention:

  1. Focus on the critical measures—outside of key service-level agreement (SLA) metrics. Following the “you can’t manage what you can’t measure” saying, health plans need to walk a fine balance between planning and managing steep volumes while also meeting Net Promoter Score (NPS) goals that retain members. To keep call quality in line with quantity, understand the consumer ask for more frictionless, convenient experience. Ensure you track progress in this area with feedback such as an NPS-tailored survey, to gauge the voice of the consumer. 
  2. Equip your workforce for the long haul. For sustained enrollment success—member retention—don’t train team members for the open enrollment period alone, train them for serving customers throughout the year. Training focused solely on moving volumes with low average handle time (AHT) and fast first call resolution (FCR) doesn’t always prioritize NPS and experience. Member feedback can be leveraged to adjust training for moments in time measurement and progress—from open enrollment and throughout the member journey.
  3. Ensure that your customer experience front line educates and engages members—beyond just responding to queries.  According to Consumer Technographics data, 41% of consumers wish that their health insurer would do more to help them understand their health insurance benefits, and 32% say their health insurer’s website is difficult to navigate and it is hard to find the information they want. With a more educative open enrollment, the first impression is not apprehension and worry, but confidence in plan choice. The health plan role shouldn’t be underestimated here, as these organizations can play an important role in steering members toward a positive health plan and health experience. Aside from the stresses of a new plan, open enrollment is the time of year when individuals are navigating medical expense avoidance—using copays wisely—with diagnostic tests and visits being scheduled. This is yet one more opportunity for plans to provide empathetic, consultative care.

Often referred to as the “Super Bowl” of customer experience, open enrollment focus and success can be carried across the calendar, with the right approach. Business Process Management firms have experience of managing interactions across countless health plans, with the best practices and domain knowledge critical to open enrollment. These experts know how to create a lasting impression, with the people, process, and technology to provide the same member experience on day one as on day 5,000. The aim is to treat every member as if they are calling for the first time—and the Super Bowl success here is measured as member retention to build and sustain growth.

Srikanth Lakshminarayanan

Srikanth Lakshminarayanan, Senior Vice President, Center of Excellence for Healthcare Engagement Services, leads the day-to-day call center practice and strategy for Sagility. He has more than 20 years of experience steering customer experience success for healthcare organizations.