Unlocking Wellness: How a Customer-First Approach Can Revolutionize Health Insurance and Improve Patient Outcomes

In today’s intricate web of traditional health insurance, countless individuals find themselves lost and frustrated. Faced with indecipherable benefits, subpar customer service, and incomprehensible cost structures, the current health insurance model seems almost designed to confuse. A recent survey commissioned by Curative revealed that healthcare members significantly lack an understanding of how to navigate their plans. Isn’t it time health plans learn from industries like retail, finance, and technology, where the customer is king? Ultimately, not focusing on the customer leaves health insurance members confused about where, when, and how to get the care they need.

Employer-sponsored health plans are often hailed as the gold standard for healthcare coverage. According to a KFF survey, these plans provide benefits to nearly 159 million nonelderly citizens – nearly half of the US population. But what happens when more than half of those insured encounter difficulties using their health insurance? Both surveys show that denied claims, network issues, and unmanageable out-of-pocket costs are more than mere inconveniences. These difficulties are preventing members from utilizing these hard-won benefits. Not surprisingly, for the people who need it most, those in poorer health reported more frequent and challenging problems.

One solution we’ve adopted at Curative is to proactively engage members from the very start with an introductory one-on-one personalized encounter we call the Baseline Visit. A Baseline Visit allows members to learn how to fully maximize their healthcare coverage and take greater ownership and control of their health and well-being. During these sessions, members consult with clinicians who provide the tools and resources they need to potentially identify and prevent health issues before they can fester.  As we all know, prevention isn’t just better than a cure — it often saves money, too.

In addition to spending time with a clinician, our Baseline Visit includes an introduction to the member’s individually assigned Healthcare Navigator.  These Navigators, who get to know you personally, are there as a hands-on resource to help guide members to the best possible solution for their healthcare needs. A quarter of all insured adults admit they find it difficult to understand specific healthcare terminologies such as “deductible,” “coinsurance,” “prior authorization,” or “allowed amount.” This gap in understanding can be bridged by having Navigators assist members in understanding these terms and assist with other difficulties members have in getting the appropriate care they need. Coupled with a 24/7 Members’ helpline, customers can get the answers they need when they need them day or night.  A properly designed customer experience goes a long way toward providing a sense of empowerment for members and builds stronger relationships with employers.

While many plans believe they can reduce costs by making it difficult for members to get answers to their questions and access the system, by emphasizing a superior member experience, engaging with members, and learning about their unique needs and wants, it is possible to reduce costs by encouraging early and appropriate interventions, thereby preventing more expensive care down the road.  As a result, members and employers can experience higher satisfaction levels and ultimately improve member longevity with their health plan and employer. A more knowledgeable, engaged membership base leads to the proper care at the right time and place, which benefits everyone.