PressGo! Industry Guide

Transcription

1 PressGo! Industry Guide To Health Care The US health care industry is going through a period of unprecedented change driven by regulation, technology and demographic changes. One of the largest sectors of the US economy, in 2011 health care accounted for over 17% of GDP and employed roughly 11 percent of the country s workers according to the McKinsey Global Institute. With average annual increases in health care expenditures of 5 percent over the past decade, the need for reform and productivity improvements is reshaping the industry. Legislative changes intended to control costs and increase access to health insurance are creating a consumerdriven market for the first time. Meanwhile, consumers increasingly are turning to digital channels to research and make their medical and insurance decisions. Coupled with intense cost-cutting pressures, this consumer interest in web, mobile and social channels is driving health care companies to migrate communications online. However, the industry is still highly dependent on print for many types of communications and is seeking ways to improve the performance and productivity of print. TABLE OF CONTENTS Market Segments 2 Table 1. Market Overview 2 Market Concentration and Brand Equity 3 Table 2. Brand Strength of Health Care Companies Source HarrisInteractive.com 3 Table 3. Ranking of Largest US Payors and Providers 4 Learning the New Rules 5 Impact on Business Communications 6 Table 4. Key Payor Business Communications 6 Table 5. Key Provider Business Communications 8 Helping Your Health Care Customers 9 Table 6. Opportunities to Help Payors 9 Table 7. Opportunities to Help Providers 11 Summary 12 Resources for Further Learning 13 Communications across all channels are becoming more strategic, segmented and measurable. Service providers with the ability to help health care communicators to control costs and increase effectiveness will find many opportunities in this market. 1

2 MARKET SEGMENTS When pursuing opportunities in the health care market, it is important to understand the two major groups that dominate the US market: Health Insurance companies and their distribution partners Healthcare Providers like Hospitals, medical practitioners and laboratories Many of the biggest challenges in the health care industry stem from coordination between Insurance companies and hospitals, or Payors and Providers who compete for the premium dollars paid by insured individuals or health plan members. In addition to these main groups, there are an increasing number of hybrid Payor/Provider organizations where insurance coverage is tied to a specific group of providers or where hospitals and hospital networks are owned by major insurance firms. TABLE 1. MARKET OVERVIEW Payors Health Insurers Pharmacy Benefi t Managers (PBMs) Traditional offers: Group health plans (through employers) Individual health plans Medicare advantage plans (replaces Medicare coverage and may provide additional features) Medicare supplement plans (offered in addition to Medicare coverage) Supplemental offers: Vision coverage Dental coverage Pharmacy coverage Providers Traditional: Community hospitals Hospital systems Hospital networks Individual physicians/specialists Labs and diagnostic services Hybrid: Accountable Care Organizations (ACO) Health Maintenance Organizations (HMO) Preferred Provider Organizations (PPO) Point of Service (POS) Marketing focus: Employers (group plans) Upsell and maintenance of existing Members (evolving) Acquisition of new Members Providers Government lobbying Marketing focus: Patient acquisition Patient retention Community outreach 2

3 MARKET CONCENTRATION AND BRAND EQUITY The payor market is highly concentrated at the national level and even more so at the regional level. Nationally, the two largest commercial insurers (see Table 3); Unitedhealth Group and Wellpoint each provide health insurance coverage to more than 30 million members and together cover approximately 23 percent of insured Americans. At a regional level, the largest five payors together account for 70 to 85 percent of all health plan enrollments. However, the largest players are not always those with the strongest brands (see Table 2) particularly when it comes to the provider side of the market. In 2011, nearly 16 percent of Americans were not covered by any health insurance including private insurance plans or government programs such as Medicare, Medicaid or Veterans benefits. Over the next few years, a large portion of this uninsured population will become prospects for marketers of individual insurance programs. The competition to develop new products and market effectively to this new demographic is having a ripple effect throughout the industry. Market opportunities exist for service providers who can help health care companies to position themselves with this new demographic while retaining business and controlling costs in existing markets. There is increasing need for brand marketing among both payors and providers. TABLE 2. BRAND STRENGTH OF HEALTH CARE COMPANIES SOURCE HARRISINTERACTIVE.COM 3

4 TABLE 3. RANKING OF LARGEST US PAYORS AND PROVIDERS Rank Payor and link to vital statistics Provider RANKING OF LARGEST INSURANCE COMPANIES National Association of Insurance Commissioners Ranking (naic.org) RANKING OF TOP FOR PROFIT HOSPITALS Leading For Profi t Hospitals in the US based on number of hospitals #1 Unitedhealth Group #2 Wellpoint Inc. Group #3 Kaiser Foundation Group Hospital Corporation of America (Nashville, TN) Number of hospitals: revenue: $29.7 billion Community Health Systems (Brentwood, TN). Number of hospitals: revenue: $113.6 billion Health Management Associates (Naples, FL) Number of hospitals: revenue: $5.8 billion #4 #5 Aetna Group (in-plant print facility) Humana Group (in-plant print facility) LifePoint Hospitals (Brentwood, TN) Number of hospitals: revenue: $3.03 billion Tenet Healthcare Corp. (Dallas TX) Number of hospitals: revenue: $9.58 billion #6 HCSC Group Health Care Services Corporation (operates BCBS plans in Illinois, New Mexico, Oklahoma and Texas) Vanguard Health System (Nashville, TN) Number of hospitals: revenue: $4.89 billion #7 #8 Coventry Corp. Group (proposal to merge with Aetna) Highmark Group (Multiple in-plant print facilities) Universal Health Services (King of Prussia, PA) Number of hospitals: 23 (acute care) 2011 revenue: $7.5 billion IASIS Healthcare (Franklin, TN) Number of hospitals: 18 (acute care) 2011 revenue: $2.8 billion #9 Independence Blue Cross Group #10 Blue Shield of CA Group Prime Healthcare Services (Ontario, CA.) Number of hospitals: revenue: Not available National Surgical Hospitals (Chicago, IL) Number of hospitals: 14 (Specialty/surgical) 2011 revenue: Not available See also Top 25 US Health Insurance Companies from US News and World Report (2011) See also 4

5 LEARNING THE NEW RULES Marketing successfully to the health care industry requires at least a basic understanding of the regulatory scrutiny these companies are under. Regulations affect all aspects of the industry from the formation of insurance products to the delivery of care by providers. The health care industry is regulated by an alphabet soup of acronyms both old and new. Regulations, regulators and guidelines affecting healthcare communications include: Centers for Medicare and Medicaid Services Department of Labor ERISA Internal Revenue Service Health and Human Services Securities and Exchange Commission State Insurance Commissions The Family and Medical Leave Act COBRA HIPAA HiTECH ICD-10 Classifications Patient Protection and Affordable Care Act Most recently, the highly debated Patient Protection and Affordable Care Act (ACA) has had a major impact on the industry and that impact will only increase in coming years. The law will require that all Americans have health insurance or pay a tax for not being covered. The law provides for individual states to create health insurance exchanges (HIX) by 2014 where individuals can compare and purchase health insurance plans. States will also have the option of deciding whether to expand Medicaid eligibility to cover additional low income citizens. Many states are currently undecided on whether to expand coverage or have not defined the terms for doing so. This lack of certainty is challenging for health insurers who must develop products for these exchanges on a state by state basis. Health insurance exchanges and a provision known as the Medical Loss Ratio or MLR are also changing the manner in which insurance products are marketed. Health insurance exchanges are a direct-to-consumer, retail format for comparing and purchasing a policy. This is a stark contrast to insurance companies traditional sales method of using brokers and Third-party Administrators (TPAs) to sell group plans to employers. To participate in exchanges, insurers must launch new products geared to individual members and learn to market them to a consumer instead of a business audience. The need to brand themselves for, market to, and compete in the consumer marketplace is creating pressure to control costs and to improve customer experience. Adding further cost pressure, the MLR is a provision of the ACA that requires insurers to spend at least 80 percent of premium dollars on actual medical benefits for insured members (85 percent for large plans.) If plans spend less than this amount, the difference is to be rebated to policy holders on an annual basis. Currently it is estimated that approximately $650 billion of the $2.6 trillion that American s spend on health care goes to overhead. The MLS provision requires payors to trim between $60 and $65 billion, or roughly 10% of current overhead costs from their budgets. A significant part of this overhead is marketing, advertising and sales commissions. Section 1104 of the ACA titled Administrative Simplification is intended to simplify and streamline billing and payment through standardization and encouragement of electronic processing. It is estimated that providers write off up to $60 billion annually in bad debt, primarily from consumers who don t pay their portion of services billed. Providers also experience significant delays in payment due to difficulty with coding services for processing of claims and a lack of accountability on timeliness of payments from payors. Administrative Simplification includes a series of standards for implementation through 2016 impacting the billing and claims process from pointof-sale through payment to providers. It also includes requirements for monitoring how quickly insurance companies are making payments. 5

6 IMPACT ON BUSINESS COMMUNICATIONS In the model where health insurance is sold by insurers directly to large employers or through Third Party Administrators to small businesses and individuals, insurance premiums are paid by employers or TPAs on behalf of members. Typically, the only communications sent directly to plan members under this scenario are required proof of coverage, ID card, Explanations of Benefit (EOBs) and any required notices of change in coverage. Even the initial Explanations of Coverage EOCs are often delivered by the employer at the time of enrollment. Notable exceptions are the marketing of Medicare Advantage and Medicare Supplement plans which are sold directly by insurers to seniors on Medicare. Implementation of the ACA along with the need to drive down costs, market to individuals and improve member experience is affecting business communications across the product lifecycle. TABLE 4. KEY PAYOR BUSINESS COMMUNICATIONS Product / Application Industry Challenges Marketing Direct marketing open enrollment. Seasonal direct mail and targeted to groups and members during open enrollment for employer sponsored plans and Medicare Advantage and Supplement Plans. Direct marketing individual plans. Non-seasonal multichannel marketing focusing on non-group. Collateral and signage. Static collateral at the corporate and plan level to support partners and retail operations. Enrollment Materials Enrollment Forms. Forms used to gather information to enroll an employee or individual in a health plan. ANOC/EOC. Annual Notice Of Change / Evidence Of Coverage Membership Identification Card. Provided at time of enrollment or as needed or required by plan sponsor post enrollment. Explanations of Coverage. EOC Booklets detailing benefits and exclusions of specific plans. ACA requires EOCs to be updated with standard definitions for insurance and medical terms. Summary Plan Description. The SPD is a legal summary of the plan benefits and overlaps somewhat with the EOC and the SBC. Summary of Benefits and Coverage. The SBC is a new, highly variable document mandated by the ACA intended to help compare plan features in a standardized way. It must be offered at enrollment and at least 60 days in advance of any plan changes. Provider Directory. Plans prefer to deliver information online but many members prefer print. The enrollment period for Medicare plans has been condensed from 6 months to 3 and overlaps group open enrollment. Information that is benefit neutral can be mailed in advance of the enrollment marketing period. The industry has little experience with direct to consumer marketing. As insurance companies establish retail storefronts there is an increased need for high end retail marketing collateral and signage. See details on Medicare Enrollment Materials Group plans are pushing to move enrollment online but print is still required and may need customization at the plan level. Applies to Medicare plans and is highly seasonal. Many plans shifting from paper ID cards to plastic. Trends toward RFID and embedding of additional member data in cards. Timely delivery is critical. There are now multiple documents describing coverage, the EOC, SBC and SPD which must be kept in synch. There are many variations of SPDs to create and manage. The SBC poses a significant challenge and expense to update, manage and distribute to plan participants and beneficiaries and volumes are difficult to forecast. Reduce print by driving members online and tailoring print by member location. Continued on next page 6

7 TABLE 4. KEY PAYOR BUSINESS COMMUNICATIONS CONTINUED Product / Application Industry Challenges Marketing Formulary Directory. A listing of the drugs a health plan will pay for. Usually this information is available online but many group plans require printed formularies to be provided. Providers may also request copies. Pharmacy directory. Similar to physician director, lists participating pharmacies in members region. A printed formulary is required for all Medicare plans. Directory required for all plan sponsors offering a Medicare Part D benefit. Wellness & Disease Management Health Assessments. Survey of individual health plan member health behaviors used to create a group risk profile and to recommend lifestyle changes to the individual. Usually results in an online or printed report to the individual. Wellness Programs. Communications, often personalized, intended to encourage the use of preventative care screenings and adoption of healthy lifestyle changes such as diet and exercise regimens. Disease Management. Ongoing communication on all aspects of dealing with a chronic medical condition such as asthma, diabetes, high-cholesterol or cancer. Communications for the patient, family, caretakers for addressing dietary and mental impacts as well as the disease itself. Program reporting. In addition to materials directed to individual members, there are aggregated reporting requirements at the group plan level to report on the effectiveness of programs and the overall risk profile of the insured population. Effective wellness programs require use of sensitive member data and therefore processes must be highly secure. In many cases, wellness programs may be tied to employee incentives for positive behaviors such as fitness activities or quitting smoking. If such programs are administered by employers they can be considered discriminatory and trigger IRS penalties or plan changes. Plans when offered by insurers are considered a competitive advantage. Coordinating individual campaign execution and reporting aggregated information to employers requires careful coordination and security. Wellness and disease management programs have been shown to significantly increase patient health and reduce health care costs. Billing, Claims and Payment (see Administrative Simplifi cation) EOB. Explanations of Benefit are explanations of claims made against health plans by members for health services. EOP. Explanations of Payments may be sent to providers or members to detail the proportion of a claim that is being paid. They may be accompanied by a check. Monthly Health Statement. In an effort to improve customer experience and track service usage, particularly for Consumer Driven Health (CDH) plans with high deductibles, plans are offering monthly summaries of claim activity. Checks. While payments are increasingly being processed online, insurers still have many check applications for responding to claims as well as normal accounts payable. Correspondence. Insurers have a wide variety of letters and notices to process related to plans for groups and individuals. Moving EOBs from a per claim basis to an aggregated reporting format. Moving EOBs online, improving clarity and augmenting with Monthly Health Statements. The ACA encourages payment activity to move online but some checks are still required. These statements are typically a much more customer friendly document requiring significant reengineering of claims data. Many insures are moving toward dynamic messaging and promotions on these documents but do not have the systems to support messaging and offers. Insurers want to avoid printing checks as a separate processing stream both for mailing efficiency and customer experience reasons. Eliminating pre-printed check stock is a cost cutting opportunity. Security and assurance against fraud is a critical concern. Many letters and notices are one off designs that need to be consolidated and managed more efficiently. Many will require redesign under administrative simplification. Continued on next page 7

8 TABLE 4. KEY PAYOR BUSINESS COMMUNICATIONS CONTINUED Product / Application Industry Challenges Corporate and Internal Communications Compliance Reporting. There is significant increased compliance reporting mandated by the ACA. Most of this information is reported online but printed copies may be requested by investors, stakeholders or for legal purposes. Investor Communications. Prospectuses, Annual reports and corporate filings for publicly traded companies. Human Resources. Payors also must offer benefits communications to their employees as well as training materials. Companies are struggling to interpret and comply with new quality and performance reporting. With all of the changes in operating procedures, management of trainer and trainee materials is a challenge. TABLE 5. KEY PROVIDER BUSINESS COMMUNICATIONS Marketing Direct Marketing Collateral and Signage Information on special program offerings such as cancer, elder care, pre-natal. Keeping information current Periodicals /Newsletters Admissions and Patient Care Forms Labels Wristbands Patient Instructions Service Reminders Disease Management Industry Challenges Hospitals are awash in preprinted forms that are poorly designed and often photocopied in poor quality at higher than necessary expense. Determining the printing technology to use for internal label production and the appropriate source for base labeling stock. Label design, including the introduction of color for enhanced patient safety is also a concern. More and more data is being added to wristbands, including patient photographs and medical alerts to enhance patient care. Patient instructions are often poorly designed and source files are poorly managed. They man entail a combination of preprinted material and form-fill components that are error prone. Service reminders are critical for patient care as well as customer experience and provider marketing success. Providers want patients to return to them for regularly scheduled services. Disease management is an ongoing communications challenge where the cost of communications are more than offset by the impact on patient adherence to treatment guidelines and corresponding health care cost reductions. Billing, Claims and Payment (see Administrative Simplifi cation) Forms Hospitals are awash in preprinted forms that are poorly designed and often photocopied in poor quality at higher than necessary expense. 8

9 HELPING YOUR HEALTH CARE CUSTOMERS In order to gain traction in the health care market, service providers need to understand the challenges that are keeping executives up at night. For every challenge, there is an opportunity for service providers to demonstrate an understanding of the problem and to present solutions for meeting their needs. Since cost control is an overarching theme in the health care market, providers must understand that a key goal of these companies is to reduce print. To succeed in this market, service providers must position themselves to profi t from both print and non-print revenues. The most successful fi rms will be able to offer strategic consulting, multi-channel marketing solutions, printed and electronic transaction communications platforms and robust data analytics. TABLE 6. OPPORTUNITIES TO HELP PAYORS Challenges Faced Opportunities to Serve Reducing ineffi ciencies and implementing standards Improving Customer Experience for Competitive Advantage Increasing Marketing Effectiveness As insurance companies struggle to meet compliance deadlines for Administrative Simplification between now and 2016, there is the risk of creating one off solutions that will drive downstream inefficiencies in managing communications. Help customers to: Reengineer documents to use new standards for language and coding while enhancing production efficiencies. Create standard templates for all document types from campaigns through enrollment and claims. Review content creation and management processes; develop automated workflows for managing templates. Standardizing communications will help customers meet compliance requirements and has the added benefit of improving customer experience. Plan members expect timely and consistent delivery of information across multiple channels. Your services can help: Review communications for brand and content consistency across channels. Provide redesign services. Provide examples from other industries to help insurance companies understand the power of cross-channel consistency including the use of social media and mobile devices. Leverage full color printing to ensure that brand consistency is maintained across channels. Enable faster production and more timely communications. Provide loyalty and wellness marketing solutions that make customers feel valued. Standardization of communications across channels will not only improve customer experience, it can make it easier to market to new customers and retain loyalty with existing customers. Helping insurance companies to embrace the consumer channel while managing existing group markets will require: Support managing and analyzing data starting with existing data sets and migrating to big data solutions. Strategic consulting to identify market segments and triggers for relevant personalization. Creation and management of personalized, multi-channel campaigns for acquisition, enrollment processing, loyalty, wellness and chronic disease management. Encourage innovative use of all channels, including cross-selling and brand marketing on transaction documents. Provide tools for measuring effectiveness and continuous improvement. Help insurers understand how to work within regulatory constraints for example sending benefit neutral educational mailings to Medicare Advantage prospects in advance of the fall marketing period to build trust and brand awareness. Continued on next page 9

10 TABLE 6. OPPORTUNITIES TO HELP PAYORS CONTINUED Challenges Faced Opportunities to Serve Controlling Business Communications Costs Establishing a Retail Environment While striving to be more competitive, serve new markets and implement myriad regulatory measures, insurers are also expected to reduce their overhead. Every aspect of producing communications must be tuned to the highest degree of efficiency without sacrificing effectiveness. Cost control involves: Clean segmented data to allow effective targeting while reducing mail volume. Data services are critical. The ability to consolidate mailings such as EOBs and checks with inline MICR and finishing solutions. The ability to drive member communications to e-presentment and e-payment platforms thereby reducing print. Making sales materials available on ipads and other tablets augmented by print on demand portals to support brokers. Optimizing postal processes through increased postal density, mail consolidation, intelligent use of USPS options and tracking services and piece level integrity. Eliminate costs from preprinting obsolescence and warehousing through digital printing. Personalized wellness and chronic disease management programs measurably reduce health care spending by consumers. Effectively managing these communications for insurers is a competitive differentiator. As health insurance companies begin to establish a retail presence in order to sell insurance direct to the consumer market, they must learn the best-practices of branch management from other industries such as financial services and retail stores. You can help by: Sharing print and procurement tactics used by other branch based clients. Providing guidelines for effective signage and signage rotation. Multi-site distribution of forms and collateral. Portals for branches to track, order and manage sales collateral. 10

11 Service providers who offer templated, web-to-print marketing solutions may fi nd opportunities with smaller providers and independent practices to support appointment reminders and marketing efforts, however, the major opportunities are to be found with big box hospitals and hybrid hospital networks who have a broader base of prospects and larger budgets. TABLE 7. OPPORTUNITIES TO HELP PROVIDERS Challenges Faced Opportunities to Serve Patient Safety Implementation of Administrative Simplifi cation Increased Marketing Demands The primary focus of any health care provider should be the quality of care given to patients. Patient safety is a concern that is increasing addressed through improved workflow and technology including Electronic Medical Records or EMR (also Electronic Health Records EHR) and RFID tagging to help reduce clinical errors and combat the counterfeiting of medicinal products. In addition there are many aspects of print that contribute to patient safety. These include Forms for admissions processing and creation of dynamic, often color-coded wrist-bands for in-patient and outpatient visits. Labels, often color coded, for medications. Patient instructions for follow on care when leaving the provider. These documents are primarily processed at point of care, but there are opportunities for design and production of collateral such as patient instructions. Administrative Simplification will have many benefits for providers including the ability to assess eligibility at the point of service and hopefully, to reduce the amount of bad debt currently faced by the industry. However, these are not tasks that staff is currently trained for and the changes to the work environment will be daunting. Providers will need intensive training of various groups over the next several years which will likely involve the management and distribution of a significant volume of training materials. As more consumers move to Consumer Directed or High-deductible insurance plans, they are more likely to shop around for services. In addition, in order to keep health care costs in line, it is critical that consumers receive standard preventative care and screening. Providers need cost effective solutions for: Community marketing and brand awareness campaigns Patient outreach including appointment reminders, screening reminders, chronic disease management and wellness campaigns. Consumer marketing campaigns highlighting specialty focus areas of large hospital providers. Philanthropic donor campaigns for not-for-profit entities. Providers, even large ones, typically do not have the marketing staff or marketing budget or marketing data that even the smallest health insurer can muster. They need help with all aspects of marketing management from planning through production and measurement. 11

12 SUMMARY The health care market in the US is facing a multi-year period of significant change, and change breeds opportunity. While it is inescapable that the current regulatory environment will force a significant portion of health care communications online, there are still significant opportunities for service providers to sell print and nonprint services. Successful service providers to this market will have a strong understanding of the pain points of health care executives coupled with a robust combination of the following offers: Data cleansing, analytics and segmentation tools. Document design and reengineering services. Strategic consulting to define market segmentation and appropriate marketing approaches. End-to-end management of multi-channel marketing campaigns including print, , web, social media and increasingly, transaction document and mobile channels. Flexible digital printing environments supporting highquality color, MICR, dynamic finishing and high-speed production. Web-2-print portals for supporting print on demand communications for brokers, retail centers and provider locations as well as templated solutions for smaller providers. Sophisticated mail management solutions and consulting to help companies to optimize their postal processes and control spending. E-presentment and archiving solutions to compliment transaction printing offers. While helping health care clients to control costs and increase communications effectiveness, service providers must not overlook the overarching focus on data security. Health care companies will seek business partners who have strong data and site security processes and who have achieved certification. While the opportunities for serving this market are great, the potential liability for exposure of personal information should not be overlooked. When approaching this market, prepare yourself with samples of health care applications you can produce as well as relevant current examples of work you produce for health care or industries that healthcare would like to emulate. Provide guidelines that will help companies to design their own communications in a way that will be compatible with your production environment and that will help them to gain efficiencies through standardization. Build trust by demonstrating that you are willing to cannibalize certain aspects of your services to provide the best solution for their needs, for example reducing print in favor of or helping them to move Explanations of Benefit online. Understand that the health care companies that you meet with today will look very different in a year or two. Gaining and maintaining clients in this industry will require that you learn, grow and change right along with them. 12